Tag: nevin manimala

PLoS One. 2022 Jun 30;17(6):e0270848. doi: 10.1371/journal.pone.0270848. eCollection 2022.

ABSTRACT

BACKGROUND: Menstruation is a biological process which is crucial for human reproduction. Menstruation is a source of absenteeism, yet the subject matter has not been well explored. This study aimed to assess the correlates of absenteeism at school, work and social activities during menstruation among Ghanaian women of reproductive age.

METHODS: This study was an analysis of secondary data from the 2017/18 Ghana Multiple Indicator Cluster Survey. Data were analysed using descriptive statistics, Chi-square and Binomial Logistic Regression with the aid of Stata/SE, version 16.

RESULTS: The majority of the participants were aged 25-49 years (63%), married/in union (55%) and resided in urban areas (52%). Nine in ten participants had access to privacy at home and 98% used menstrual materials during their last period. Eight in ten participants used disposable menstrual materials. Exactly 19% of the participants missed school, work or social activities during their last period. Participants who used disposable menstrual materials (AOR = 0.67; 95% CI: 0.52-0.85) were less likely to miss school, work or social activities during menstruation compared to those who used reusable menstrual materials.

CONCLUSION: This study demonstrated that a significant minority of women in Ghana miss academic, economic or social activities during menstruation. Therefore, there is a need for effective interventions to help reduce menstruation-related absenteeism among women and girls in Ghana.

PMID:35771899 | DOI:10.1371/journal.pone.0270848

PLoS One. 2022 Jun 30;17(6):e0270340. doi: 10.1371/journal.pone.0270340. eCollection 2022.

ABSTRACT

BACKGROUND: China established the Tiered-network Healthcare Delivery System (THDS) in 2015 to address the disproportionate number of patients attending tertiary hospitals relative to primary- or secondary-care institutions. Although the reported number of outpatients visiting tertiary hospitals is slowly decreasing, numerous patients choose to visit them regardless of their disease’s severity. To effectively implement the THDS, this article explored the relationship between patients’ sociodemographic and belief characteristics and their healthcare-seeking behavioral decision-making in China.

METHODS: Data obtained through questionnaires were analyzed using decision tree and logistic regression models to explore outpatients’ characteristics and medical decision-making using comprehensive feature data. Moreover, further statistical analyses were conducted on the outpatient data obtained from the regional population health platform in Jiaxing, China.

RESULTS: The decision tree model revealed that whether outpatients have medical insurance is the primary factor guiding their healthcare-seeking behaviors, with those without medical insurance more likely to choose primary or secondary hospitals to treat minor diseases. For those with medical insurance, profession is the main factor, with industrial workers more inclined to choose primary or secondary hospitals for minor diseases. The logistic regression analyses revealed that outpatients without insurance and who were not freelancers or individual owners were more likely to choose primary or secondary hospitals for minor diseases. Further statistical analysis of the data from the Jiaxing population health platform showed that, for minor or general diseases, outpatients without medical insurance and employed as farmers tended to choose primary and secondary hospitals over tertiary hospitals.

CONCLUSION: The three analyses yielded consistent results: in China, medical insurance and patients’ profession are the most important factors guiding outpatients’ healthcare-seeking behaviors. Accordingly, we propose that the government should focus on economic reforms to increase outpatients’ visits to primary and secondary hospitals and diagnosis-related groups’ payment of medical insurance to decrease the admittance of patients with minor diseases in large tertiary hospitals. Meanwhile, the government should correct patients’ belief prejudice about selecting hospitals through corresponding publicity.

PMID:35771896 | DOI:10.1371/journal.pone.0270340

PLoS Med. 2022 Jun 30;19(6):e1004043. doi: 10.1371/journal.pmed.1004043. Online ahead of print.

ABSTRACT

BACKGROUND: The evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle).

METHODS AND FINDINGS: We carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales. Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas. Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis.

CONCLUSIONS: Our study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.

PMID:35771888 | DOI:10.1371/journal.pmed.1004043

PLoS One. 2022 Jun 30;17(6):e0270497. doi: 10.1371/journal.pone.0270497. eCollection 2022.

ABSTRACT

BACKGROUND: Actovegin is a hemodialysate of calf’s blood and has been used for several decades in the countries of Central Asia, East Asia, Russia and some European countries. It has been used to treat patients with various neurological conditions, vascular disorders, and ischemic stroke.

OBJECTIVES: To perform a systematic review to evaluate the effect of Actovegin in patients who have suffered an ischemic stroke.

METHODS: A search of MEDLINE, PubMed, Cochrane and Embase was carried out from inception to October 10, 2021 for clinical trials and observational studies with a control group, published in English or Russian.

RESULTS: Of 220 identified unique records, 84 full-text articles were screened, and 5 studies were selected that met the inclusion criteria. This included 4 observational studies with control groups and one randomized, placebo-controlled clinical trial. These studies enrolled a total of 3879 patients of which 720 patients received Actovegin administered intravenously and/or orally for a duration ranging from 10 to 180 days. Because of study heterogeneity, meta-analysis was not performed. No consistent evidence on improved survival, quality of life, neurologic symptoms, activities of daily living or disability was identified. One study showed statistically significant improvements in the Alzheimer’s Disease Assessment Scale, cognitive subscale, extended version (ADAS-cog+) for Actovegin compared with placebo at 6 months but the clinical relevance of this change is uncertain. One study reported a higher incidence of recurrent ischemic stroke, transient ischemic attack or intracerebral hemorrhage in patients taking Actovegin compared to placebo.

CONCLUSIONS: The benefits of Actovegin are uncertain and that there is potential risk of harm in patients with stroke. More evidence is needed from rigorously designed clinical trials to justify the role of Actovegin in patients with ischemic stroke.

PMID:35771887 | DOI:10.1371/journal.pone.0270497

PLoS One. 2022 Jun 30;17(6):e0270194. doi: 10.1371/journal.pone.0270194. eCollection 2022.

ABSTRACT

Election forecasting has been traditionally dominated by subjective surveys and polls or methods centered upon them. We have developed a novel platform for forecasting elections based on agent-based modeling (ABM), which is entirely independent from surveys and polls. The platform uses statistical results from objective data along with simulation models to capture how voters have voted in past elections and how they are likely to vote in an upcoming election. We screen for models that can reproduce results that are very close to the actual results of historical elections and then deploy these selected models to forecast an upcoming election with simulations by combining extrapolated data from historical demographic record and more updated data on economic growth, employment, shock events, and other factors. Here, we report the results of two recent experiments of real-time election forecasting: the 2020 general election in Taiwan and six states in the 2020 general election in the United States. Our mostly objective method using ABM may transform how elections are forecasted and studied.

PMID:35771877 | DOI:10.1371/journal.pone.0270194

J Natl Cancer Inst. 2022 Jun 30:djac125. doi: 10.1093/jnci/djac125. Online ahead of print.

ABSTRACT

BACKGROUND: Breast cancer (BC) risk is increased among Hodgkin lymphoma (HL) survivors treated with chest radiotherapy. Case-control studies showed a linear radiation dose-response relationship for estimated dose to the breast tumor location. However, these relative risks cannot be used for absolute risk prediction of BC anywhere in the breasts. Furthermore, the independent and joint effects of radiation dose and irradiated volumes are unclear. Therefore, we examined the effects of mean breast dose and various dose-volume parameters on BC risk in HL patients.

METHODS: We conducted a nested case-control study of BC among five-year HL survivors (173 cases, 464 matched controls). Dose-volume histograms (DVHs) were obtained from reconstructed voxel-based three-dimensional dose distributions. Summary parameters of DVH were studied next to mean and median breast dose, Gini index and the new dose metric mean absolute difference (MAD) of dose, using categorical and linear excess odds ratio (EOR) models. Interactions between dose-volume parameters and mean dose were also examined.

RESULTS: Statistically significant linear dose-response relationships were observed for mean breast dose (EOR/Gy: 0.19; 95% confidence interval [CI]: 0.05 to 1.06) and median dose (EOR/Gy: 0.06; 95% CI: 0.02 to 0.19), with no statistically significant curvature. All metrics except Gini and MAD were positively correlated with each other. These metrics all showed similar patterns of dose-response that were no longer statistically significant when adjusting for mean dose. No statistically significant modification of the effect of mean dose was observed.

CONCLUSION: Mean breast dose predicts subsequent BC risk in long-term HL survivors.

PMID:35771630 | DOI:10.1093/jnci/djac125

JMIR Mhealth Uhealth. 2022 Jun 30;10(6):e37086. doi: 10.2196/37086.

ABSTRACT

BACKGROUND: There has been a rapid increase in the use of commercially available activity trackers, such as Fitbit, in physical activity intervention research. However, little is known about the long-term sustained use of trackers and behavior change after short-term interventions.

OBJECTIVE: This study aims to use minute-level data collected from a Fitbit tracker for up to 2 years after the end of a randomized controlled trial to examine patterns of Fitbit use and activity over time.

METHODS: Participants in this secondary data analysis were 75 female breast cancer survivors who had been enrolled in a 12-week physical activity randomized controlled trial. Participants randomized to the exercise intervention (full intervention arm) received a Fitbit One, which was worn daily throughout the 12-week intervention, and then were followed for 2 years after the intervention. Participants randomized to the waitlist arm, after completing the randomized controlled trial, received a Fitbit One and a minimal version of the exercise intervention (light intervention arm), and then were followed for 2 years after the intervention. Average and daily adherence and MVPA were compared between the 2 groups in the interventional and postinterventional periods using both linear and generalized additive mixed effects models.

RESULTS: Adherence to wearing the Fitbit during the 12-week intervention period was significantly higher in the full intervention arm than in the light intervention arm (85% vs 60%; P<.001). Average adherence was significantly lower for both study arms during the follow-up period than in the intervention period; however, there were statistically different patterns of adherence during the follow-up period, with the light intervention arm having steeper declines than the full intervention arm over time (P<.001). Similar to the adherence results, mean minutes of Fitbit-measured MVPA was higher for the full intervention arm than for the light intervention arm during the 12-week intervention period (mean MVPA 27.89 minutes/day, SD 16.38 minutes/day vs 18.35 minutes/day, SD 12.64 minutes/day; P<.001). During the follow-up period, average MVPA was significantly lower than the 12-week intervention period for both the full intervention arm (21.74 minutes/day, SD 24.65 minutes/day; P=.002) and the light intervention arm (15.03 minutes/day, SD 13.27 minutes/day; P=.004). Although the mean MVPA in each arm was similar across the follow-up period (P=.33), the pattern of daily MVPA was significantly different between the 2 groups (P<.001).

CONCLUSIONS: While adherence to wearing activity trackers and maintaining physical activities declined after completion of a 12-week exercise intervention, a more active interventional strategy resulted in greater wear time and activity levels during the intervention and more stable patterns of adherence and activity in the long term. An improved understanding of long-term maintenance patterns may inform improved exercise interventions that result in sustained increases in physical activity.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876.

PMID:35771607 | DOI:10.2196/37086

Cochrane Database Syst Rev. 2022 Jun 30;6:CD005996. doi: 10.1002/14651858.CD005996.pub4.

ABSTRACT

BACKGROUND: The use of peri-implantation glucocorticoids has been advocated to improve embryo implantation during assistive reproductive technology (ART) cycles such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). It has been proposed that glucocorticoids may improve the intrauterine environment by acting as immunomodulators to reduce the uterine natural killer (NK) cell count and activity, normalising the cytokine expression profile in the endometrium and by suppression of endometrial inflammation.

OBJECTIVES: To evaluate the effectiveness and safety of glucocorticoids versus no glucocorticoids administered around the time of anticipated implantation in women undergoing IVF or ICSI.

SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group specialised register, CENTRAL (now also containing output from two trial registers and CINAHL), MEDLINE and Embase, on 20 December 2021, together with reference checking, contact with experts in the field and relevant conference proceedings to identify additional studies. This review is an update of the review first published in 2007 and last updated in 2012.

SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing the efficacy of supplementary systemic administration of glucocorticoids in the peri-implantation period with a placebo or no glucocorticoids in subfertile women undergoing IVF or ICSI were included.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. The primary review outcomes were live birth rate and multiple pregnancy.

MAIN RESULTS: We included 16 RCTs (2232 couples analysed). We are uncertain whether glucocorticoids improved live birth rates (odds ratio (OR) 1.37, 95% confidence interval (CI) 0.69 to 2.71; 2 RCTs, n = 366; I² = 7%; very low-certainty evidence). This suggests that if the chance of live birth following no glucocorticoids/placebo is assumed to be 9%, the chance following glucocorticoids would be between 6% and 21%. We are also uncertain whether there was a difference between peri-implantation glucocorticoids on multiple pregnancy rates per couple (OR 0.86, 95% CI 0.33 to 2.20; 4 RCTs, n = 504; I² = 53%; very low-certainty evidence). The I² of 53% may represent moderate statistical heterogeneity and results have to be interpreted with caution. With regard to pregnancy rates, we are uncertain whether there was a difference between ongoing pregnancy rates after glucocorticoids versus no glucocorticoids/placebo (OR 1.19, 95% CI 0.80 to 1.76; 3 RCTs, n = 476; I² = 0%; very low-certainty evidence) and clinical pregnancy rates after glucocorticoids versus no glucocorticoids/placebo (OR 1.17, 95% CI 0.95 to 1.44; 13 RCTs, n = 1967; I² = 0%; low-certainty evidence). This suggests that if the chance of clinical pregnancy following no glucocorticoids/placebo is assumed to be 25%, the chance following glucocorticoids would be between 24% and 32%. Furthermore, we are also uncertain whether peri-implantation glucocorticoids influenced miscarriage rates per couple (OR 1.09, 95% CI 0.63 to 1.87; 6 RCTs, n = 821; I² = 0%; very low-certainty evidence), the incidence of ectopic pregnancies per couple (OR 2.28, 95% CI 0.33 to 15.62; 3 RCTs, n = 320; I² = 0%; very low-certainty evidence) and ovarian hyperstimulation syndrome (OHSS) per couple (OR 1.07, 95% CI 0.60 to 1.90; 3 RCTs, n = 370; I² = 0%; very low-certainty evidence) compared to no glucocorticoids/placebo. The evidence was very low to low certainty: the main limitations were serious risk of bias due to poor reporting of study methods, and serious imprecision.

AUTHORS’ CONCLUSIONS: Overall, there was insufficient evidence that administration of peri-implantation glucocorticoids in IVF/ICSI cycles influenced clinical outcomes. These findings were limited to the routine use of glucocorticoids in subfertile women undergoing IVF or ICSI.

PMID:35771604 | DOI:10.1002/14651858.CD005996.pub4

JAMA Netw Open. 2022 Jun 1;5(6):e2219651. doi: 10.1001/jamanetworkopen.2022.19651.

ABSTRACT

IMPORTANCE: Substance use disorders (SUDs) are major contributors to morbidity and mortality globally, but they are often underrecognized and underdiagnosed, particularly in some sociodemographic subgroups. Understanding the extent to which clinical diagnoses underestimate these conditions within subgroups is imperative to achieving equitable treatment, regardless of race, ethnicity, gender, or age, and to informing and improving performance monitoring.

OBJECTIVE: To compare clinically documented diagnosis rates of alcohol use disorder (AUD), drug use disorder (DUD), and total SUD (AUD and/or DUD) with the prevalence of these disorders as reported in surveys-based on structured, validated diagnostic assessments-across demographic subgroups.

DESIGN, SETTING, AND PARTICIPANTS: A telephone-based survey was conducted from January 8, 2018, to April 30, 2019, among 5995 Veterans Health Administration (VHA) outpatients who were randomly sampled from 30 VHA facilities and were 18 years of age or older, could complete the survey in English, and had a valid address and telephone number. Survey data were linked to electronic health record (EHR) data for all participants. Statistical analysis was performed between January 29, 2020, and April 20, 2021.

EXPOSURES: Demographic subgroups based on self-report: gender (male or female), age (18-34, 35-49, 50-64, 65-74, and ≥75 years), and race and ethnicity (Black non-Hispanic, Hispanic, multiracial, other [Asian or Asian-American, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, and any other race endorsed by the participant], and White non-Hispanic).

MAIN OUTCOMES AND MEASURES: Survey-based prevalence rates of AUD, DUD, and SUD were assessed using the Mini International Neuropsychiatric Interview, version 7.0, the only validated instrument available at study outset that measured Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for past 12-month diagnoses. Clinically documented diagnosis rates were measured using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses from VHA EHR data. Analyses compared survey-based prevalence rates of AUD, DUD, and SUD with diagnosis rates using sensitivity and specificity and difference-in-difference analysis. All analyses were weighted with survey weights to account for nonresponse.

RESULTS: Of 5995 participants, 4115 (68.6%) were White non-Hispanic, and 5429 (91.1%) were male; the mean (SD) age was 61.5 (15.3) years. The survey-based prevalence rates of AUD, DUD, and SUD were higher than the diagnosis rates among all patients (AUD, 608 [10.1%] vs 360 [6.0%]; DUD, 282 [4.7%] vs 275 [4.6%]; SUD, 768 [12.8%] vs 515 [8.6%]). Survey-based prevalence rates of AUD and SUD exceeded the diagnosis rates in every demographic subgroup. Gaps between diagnosis rates and survey-based prevalence rates for AUD and SUD were largest among patients aged 18 to 34 years (AUD diagnosis rate, 27 [6.9%; 95% CI, 4.8%-9.9%] vs AUD prevalence rate, 88 [22.4%; 95% CI, 17.3%-28.5%]; SUD diagnosis rate, 41 [10.5%; 95% CI, 8.1%-13.4%] vs SUD prevalence rate, 109 [27.7%; 95% CI, 22.6%-33.3%]) and Hispanic and Latinx patients (AUD diagnosis rate, 31 [7.6%; 95% CI, 5.3%-10.8%] vs AUD prevalence rate, 72 [17.7%; 95% CI, 14.0%-22.1%]; and SUD diagnosis rate, 48 [11.7%; 95% CI, 7.9%-16.9%] vs SUD prevalence rate, 88 [21.6%; 95% CI, 18.0%-25.8%]). For DUD, only patients aged 18 to 34 years had a true prevalence rate that significantly exceeded the diagnosis rate (diagnosis rate, 21 [5.4%; 95% CI, 3.7%-7.8%] vs prevalence rate, 40 [10.1%; 95% CI, 7.2%-14.0%]).

CONCLUSIONS AND RELEVANCE: The results of this survey study suggest that existing diagnostic procedures and tools are insufficient to capture SUD prevalence rates, particularly among younger patients and Hispanic and Latinx patients. Clinics and health systems should implement standardized SUD assessments to ensure the provision of equitable care and the optimal identification of underlying conditions for performance monitoring.

PMID:35771574 | DOI:10.1001/jamanetworkopen.2022.19651

JAMA Netw Open. 2022 Jun 1;5(6):e2219657. doi: 10.1001/jamanetworkopen.2022.19657.

NO ABSTRACT

PMID:35771578 | DOI:10.1001/jamanetworkopen.2022.19657