Tag: nevin manimala

BMC Med Educ. 2022 Jun 27;22(1):503. doi: 10.1186/s12909-022-03558-6.

ABSTRACT

BACKGROUND: Discrimination due to gender and ethnicity has been found to be widespread in medicine and healthcare. Swedish and European legislation list seven discrimination grounds (age, sex, ethnicity, religion, sexuality, non-binary gender identity, and disability) which may intersect with each other; yet these have only been sparsely researched. The aim of this study was to assess the extent of discrimination, based on these seven discrimination grounds, amongst final-year medical students in Sweden.

METHODS: A web-based survey, based on the CHERRIES-checklist, was disseminated to course coordinators and program directors in charge of final year medical students at all seven medical schools in Sweden. Quantitative data were analyzed using descriptive statistics, Fisher’s exact test, and logistic regression. Free-text answers were analyzed thematically using the “Master Suppression techniques” conceptual framework.

RESULTS: Of the 1298 medical students contacted, 247 (19%) took part in the survey. Almost half (n = 103, 42%) had experienced some form of discrimination, and this difference was statistically significant by gender (p = 0.012), self-perceived ethnicity (p < 0.001), country of birth other than Scandinavia (p < 0.001) and visible religious signs (p = 0.037). The most common type of discrimination was gender-based (in 83% of students who had experienced discrimination), followed by age (48%), and ethnicity (42%). In the logistic regression, women/non-binary gender (p = 0.001, OR 2.44 [95% CI 1.41-4.22]), country of birth not in Scandinavia (p < 0.001, OR 8.05 [2.69-24.03]), non-Caucasian ethnicity (p = 0.04, OR 2.70 [1.39-5.27]), and disability (p = 0.02, OR 13.8 [1.58-12040]) were independently associated with discrimination. Half of those who had experienced religion-based discrimination and nearly one-third of victims of ethnicity-based discrimination reported “large” or “extreme” impact of this. Clinical staff or supervisors were the most common offenders (34%), closely followed by patients and their relatives (30%), with non-Caucasian respondents significantly more likely to experience discrimination by patients (p < 0.001).

CONCLUSIONS: Discrimination appears to be frequent in medical school, even in one of the world’s “most equal countries”. Discrimination is most commonly gender- or ethnicity-based, with ethnicity- and religion-based discrimination appearing to have the largest impact. Future research should continue to evaluate discrimination from an intersectional perspective, adapted for local contexts and legislations.

PMID:35761244 | DOI:10.1186/s12909-022-03558-6

BMC Womens Health. 2022 Jun 27;22(1):262. doi: 10.1186/s12905-022-01842-7.

ABSTRACT

BACKGROUND: In May 2018, following the preliminary results of a study in Botswana that reported congenital anomalies in babies born to HIV-positive women taking dolutegravir drug, the WHO issued a teratogenicity alert. However, there are scarce data on the impact of this guidance on contraceptive uptake among women taking dolutegravir. We assessed the uptake of contraceptives in HIV-positive women of reproductive age on dolutegravir regimens.

METHODS: We conducted a cross-sectional survey from April 2019 to July 2019 in five government health facilities in central Uganda, where dolutegravir-based regimens were offered as the preferred first-line antiretroviral treatment. We randomly selected 359 non-pregnant women aged 15-49 years taking dolutegravir-based regimens and interviewed them using semi-structured interviewer-administered questionnaires. We collected data on demographics, contraceptive use, individual, social, and health system factors. We described patients’ characteristics using descriptive statistics and assessed factors associated with contraceptive uptake using a modified Poisson regression model.

RESULTS: A total of 359 women were included in the study. The mean age was 37 years (standard deviation = 6.8) and overall contraceptive uptake was 38.4%. The most utilized method was injectable method at 58.4% followed by condoms (15%), intrauterine device (10.7%), pills (6.4%), implants (5.4%), and sterilization (0.7%). Predictors for contraceptive uptake were parity of 3-4 children (Adjusted Prevalence Ratio (APR) = 1.48, 95% confidence interval (CI): 1.14, 1.92) in reference to those with 1-2 children. There was reduced contraceptive uptake in women of the age range 40-49 years (APR = 0.45, CI: 0.21-0.94) compared to those aged 15-24 years. Unemployed women were less likely to use contraceptives (APR: 0.6, CI: 0.42- 0.94) than the formally employed. Contraceptive uptake was lower among women who did not discuss family planning with their partners (APR = 0.39, CI: 0.29-0.52) than those who discussed family planning with their partners and women who did not receive family planning counseling (APR = 0.56, CI: 0.34-0.92) than those who received family planning counselling.

CONCLUSION: We observed a low-level uptake of contraceptives, with injectables as the most used method. Family planning counseling and partner discussion on family planning were associated with contraceptive uptake among the women who used dolutegravir-based regimens. There is a need for more strategies to integrate FP services and increase male involvement in HIV care programs.

PMID:35761248 | DOI:10.1186/s12905-022-01842-7

AIDS Res Ther. 2022 Jun 27;19(1):29. doi: 10.1186/s12981-022-00451-6.

ABSTRACT

BACKGROUND: There is no other better way to safeguard an infant’s health in the first 6 months of life than exclusive breastfeeding (EBF). Breast milk is valuable in all aspects of an infant’s physical and mental growth as well as immune development. The study aimed to assess the prevalence and factors associated with EBF practice among HIV-infected mothers in the Southern Highlands of Tanzania.

METHOD: A hospital-based analytical cross-sectional study was conducted among lactating HIV-infected mothers. A random sampling procedure was used to obtain 372 HIV-infected mothers of infants from 6 to 12 months of age who were still breastfeeding at the time of data collection. An interviewer-administered structured questionnaire was used for data collection. Bivariate and multivariable logistic regression was used to assess factors associated with EBF practice. Statistical package for social science (SPSS volume 20) software was used for data entry and analysis.

RESULTS: The prevalence of EBF practice was 58.1% at 95% Confidence Interval of 52.9% to 63.1%. More than half of the respondents 199 (53.5%) had adequate knowledge while 173(46.5%) had inadequate knowledge about EBF. After adjusting for confounders, factors associated with EBF practice were knowledge about EBF [Adequate knowledge (AOR = 5.11 at 95% CI 3.2-8.17, p < 0.001)], ANC visits [Adequate (AOR = 1.76 at 95% CI 1.09-2.82, p = 0.002)], Income per day [1 0r more USD (AOR = 1.83 at 95% CI 1.14-2.94, p = 0.013)], positive perception of EBF [ positive perception (AOR = 3.51 at 95% CI 2.25-5.47, p < 0.001) and having ever experienced a breast problem AOR = 3.91 at 95% CI 1.89-8.08, p < 0.001.

CONCLUSION: More than half of interviewed mothers with HIV practiced EBF. The EBF practice among HIV lactating mothers was significantly influenced by adequate knowledge of EBF, positive perception toward EBF, adequate ANC visits, and having never experienced breast problems. Strengthening adherence to ANC routine visits, counseling on breastfeeding, and improving mothers’ knowledge about exclusive breastfeeding would contribute to the enhancement of EBF practice in this region. An innovative interventional study is recommended to develop more effective strategies to improve EBF knowledge and practice among HIV-infected mothers.

PMID:35761241 | DOI:10.1186/s12981-022-00451-6

BMC Pulm Med. 2022 Jun 27;22(1):254. doi: 10.1186/s12890-022-02049-0.

ABSTRACT

BACKGROUND: Asthma is a chronic inflammatory disease of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness and coughing. Inhaled drugs on a daily basis are the cornerstone of asthma treatment, therefore, patient adherence is very important.

METHODS: We performed a multicenter, open, non-interventional, observational, prospective study of 716 adult patients diagnosed with asthma receiving FDC (Fixed-dose combination) budesonide/formoterol via the Elpenhaler device. We assessed the adherence to treatment at 3 and 6 months (based on the MMAS-8: 8-item Morisky Medication Adherence Scale), the quality of life and change in forced expiratory volume in 1 s (FEV1) from baseline to follow-up.

RESULTS: Approximately 80% of the patients showed medium to high adherence throughout the study. The mean (SD) MMAS-8 score at 6 months was 6.85 (1.54) and we observed a statistically significant shift of patients from the low adherence group to the high adherence group at 6 months. Moreover, after 6 months of treatment with FDC budesonide/formoterol, we observed an increase in the patients’ quality of life that as expressed by a change 2.01 (95%CI 1.93-2.10) units in Mini AQLQ (p < 0.0001) that was more pronounced in the high adherence group. The same trend was also observed in terms of spirometry (mean FEV1 2.58 L (0.85) at the end of the study, increased by 220 mL from baseline) with a higher improvement in the medium and high adherence groups.

CONCLUSIONS: Treatment with FDC of budesonide/formoterol via the Elpenhaler device was associated with improvement in asthma-related quality of life and lung function over 6 months that were more prominent in patients with higher adherence.

TRIAL REGISTRATION: 2017-HAL-EL-74 (ClinicalTrials.gov Identifier: NCT03300076).

PMID:35761234 | DOI:10.1186/s12890-022-02049-0

BMC Pulm Med. 2022 Jun 27;22(1):252. doi: 10.1186/s12890-022-02048-1.

ABSTRACT

PURPOSE: Smoking cessation in patients with diagnosed lung cancer has positive effects on cancer therapy and overall prognosis. Despite this, knowledge on smoking cessation in lung cancer patients is sparse.

METHODS: This is an observational single centre, 12-week, prospective, single-arm trial at a tertiary lung cancer centre. Responsive patients were enrolled following confirmed lung cancer diagnosis. Smoking cessation intervention included counselling as well as pharmacotherapy. The primary endpoint was the point prevalence abstinence rate at week 12 based on biochemical verification. Secondary endpoints were the abstinence rate at week 26, quality of life and side effects.

RESULTS: 80 patients were enrolled. Mean age was 62.6 ± 7.9 years. Most patients (63%) were treated with chemotherapy or radiochemotherapy. 39 patients used nicotine replacement therapy, 35 varenicline whereas six patients did not use pharmacotherapy. During the study period 13 patients died. Data were available in 72 patients after 12 weeks and 57 patients at week 24. Point prevalence abstinence rates were 37.5% (95% CI 26.4-49.7%) at week 12 and 32.8% (95% CI 21.8-45.4%) at week 26, respectively. Quality of life and side effects were not significantly affected by pharmacotherapy.

CONCLUSION: In conclusion, our results suggest that smoking cessation is feasible in patients with newly diagnosed lung cancer. The observed abstinence rate is comparable to other patient cohorts. Furthermore, pharmacotherapy in addition to cancer therapy was safe and did not show novel side effects in these seriously ill patients. Thus, smoking cessation should be an integral part of lung cancer treatment. Trial registration The study was conducted in accordance with good clinical practice standards (GCP) and approved by the local ethics committee (16/3/14), the European PAS registry (EUPAS8748) and the German BfArM (NIS-Studien-Nr. 5508). All patients provided written informed consent before study enrollment.

PMID:35761222 | DOI:10.1186/s12890-022-02048-1

BMC Womens Health. 2022 Jun 27;22(1):259. doi: 10.1186/s12905-022-01834-7.

ABSTRACT

BACKGROUND: Despite the observed decrease in female genital mutilation (FGM) prevalence, it is increasingly being medicalized. We examined the attitudes of both parents towards the FGM practice in Egypt, and highlighted the effect of fathers’ decision making and attitudes towards FGM and violence on FGM practice and medicalization.

METHODS: This study is a secondary analysis of Egypt Health Issues Survey (EHIS), 2015. The 2015 EHIS involved a systematic random selection of a subsample of 614 Shiakhas/villages out of the 884 shiakhas/villages that had been chosen as Primary Sampling Units in the 2014 EDHS. Descriptive statistics of the study sample and parents’ attitudes was performed. Three indices were created describing; mothers’ and fathers’ attitudes towards FGM, decision making and rejecting violence against women. Bivariate and multivariable analyses were conducted to identify predictors of FGM practice and medicalization.

RESULTS: A considerable proportion of EHIS girls; 16.4% were circumcised and 36% of girls were expected to be circumcised. More than two thirds of circumcised girls were circumcised by a physician; namely 67% and 13.5% by nurses. The majority of mothers (88.4%) and fathers (84.8%) believed that FGM practice should continue. They believed that FGM is a religious obligation (72.3% of mothers and 73% of fathers). Parents believed that husbands prefer a circumcised wife (81.1% and 82.5% of mothers and fathers respectively). Being in the poorest wealth quintile (OR = 4.2, p < 0.001) and living in rural Upper Egypt (OR = 4.55, p < 0.001) were the predictors of FGM practice, while medicalization was more likely among the rich and educated parents. Parents’ attitudes supporting FGM was significantly associated with its practice (OR = 1.97, p < 0.001, for mothers and OR = 1.27, p < 0.001, for fathers). Rejecting violence against women was associated with less likelihood of practicing FGM (OR = 0.89, p < 0.05) and more likelihood of its medicalization (OR = 1.25, p < 0.01).

CONCLUSION: More attention should be paid to enforce the laws against FGM practice by health care providers. Raising the community awareness on girls’ human rights and elimination of FGM practice which is a severe form of violence against women and gender inequality in sexual rights should be prioritized with targeting men in FGM programs.

PMID:35761227 | DOI:10.1186/s12905-022-01834-7

BMC Musculoskelet Disord. 2022 Jun 27;23(1):615. doi: 10.1186/s12891-022-05552-x.

ABSTRACT

BACKGROUND: Facet tropism (FT) can be defined as the angular difference between the orientation of the right and left facet joints in axial or sagittal planes. Most studies discuss about the relationship with lumbar disc hernia and facet joint angle. However, little is known about the association of facet tropism with disc herniation in the cervical spine in multisports athletes. In this study, We aimed to investigate the relationship between cervical facet tropism and disc hernia in athletes of different branches between the ages of 20-40 from the cervical MR images of the cases.

METHODS: This is a retrospective study performed on athletes who applied our hospital between January 2014-2019 with neck pain and have MR imaging of the cervical spine. Cervical MR images of the patients were evaluated by an experienced radiologist from the hospital system database and archives. 79 cases (52 men and 27 women) were included in the study.

RESULTS: No statistically significant difference was found between the facet joint angles of both groups at all levels (p˃0.05). Only left C6-7 disc angles of CDH group were measured as 92.99° ± 10.77⁰ (62⁰-113⁰) and 88.58° ± 7.65° (67°-110°) for the normal group and this difference was found statistically significant (p = 0.007).

CONCLUSION: In this study, we did not predict that cervical facet tropism may be a factor associated with cervical disc hernia in young athletes with CDH.

PMID:35761220 | DOI:10.1186/s12891-022-05552-x

BMC Public Health. 2022 Jun 27;22(1):1258. doi: 10.1186/s12889-022-13429-w.

ABSTRACT

BACKGROUND: Mass immunization is a potentially effective approach to finally control the local outbreak and global spread of the COVID-19 pandemic. However, it can also lead to undesirable outcomes if mass vaccination results in increased transmission of effective contacts and relaxation of other public health interventions due to the perceived immunity from the vaccine.

METHODS: We designed a mathematical model of COVID-19 transmission dynamics that takes into consideration the epidemiological status, public health intervention status (quarantined/isolated), immunity status of the population, and strain variations. Comparing the control reproduction numbers and the final epidemic sizes (attack rate) in the cases with and without vaccination, we quantified some key factors determining when vaccination in the population is beneficial for preventing and controlling future outbreaks.

RESULTS: Our analyses predicted that there is a critical (minimal) vaccine efficacy rate (or a critical quarantine rate) below which the control reproduction number with vaccination is higher than that without vaccination, and the final attack rate in the population is also higher with the vaccination. We also predicted the worst case scenario occurs when a high vaccine coverage rate is achieved for a vaccine with a lower efficacy rate and when the vaccines increase the transmission efficient contacts.

CONCLUSIONS: The analyses show that an immunization program with a vaccine efficacy rate below the predicted critical values will not be as effective as simply investing in the contact tracing/quarantine/isolation implementation. We reached similar conclusions by considering the final epidemic size (or attack rates). This research then highlights the importance of monitoring the impact on transmissibility and vaccine efficacy of emerging strains.

PMID:35761216 | DOI:10.1186/s12889-022-13429-w

BMC Cancer. 2022 Jun 27;22(1):706. doi: 10.1186/s12885-022-09780-1.

ABSTRACT

BACKGROUND: Clinical management of women carrying a germline pathogenic variant (PV) in the BRCA1/2 genes demands for accurate age-dependent estimators of breast cancer (BC) risks, which were found to be affected by a variety of intrinsic and extrinsic factors. Here we assess the contribution of polygenic risk scores (PRSs) to the occurrence of extreme phenotypes with respect to age at onset, namely, primary BC diagnosis before the age of 35 years (early diagnosis, ED) and cancer-free survival until the age of 60 years (late/no diagnosis, LD) in female BRCA1/2 PV carriers.

METHODS: Overall, estrogen receptor (ER)-positive, and ER-negative BC PRSs as developed by Kuchenbaecker et al. for BC risk discrimination in female BRCA1/2 PV carriers were employed for PRS computation in a curated sample of 295 women of European descent carrying PVs in the BRCA1 (n=183) or the BRCA2 gene (n=112), and did either fulfill the ED criteria (n=162, mean age at diagnosis: 28.3 years, range: 20 to 34 years) or the LD criteria (n=133). Binomial logistic regression was applied to assess the association of standardized PRSs with either ED or LD under adjustment for patient recruitment criteria for germline testing and localization of BRCA1/2 PVs in the corresponding BC or ovarian cancer (OC) cluster regions.

RESULTS: For BRCA1 PV carriers, the standardized overall BC PRS displayed the strongest association with ED (odds ratio (OR) = 1.62; 95% confidence interval (CI): 1.16-2.31, p<0.01). Additionally, statistically significant associations of selection for the patient recruitment criteria for germline testing and localization of pathogenic PVs outside the BRCA1 OC cluster region with ED were observed. For BRCA2 PV carriers, the standardized PRS for ER-negative BC displayed the strongest association (OR = 2.27, 95% CI: 1.45-3.78, p<0.001).

CONCLUSIONS: PRSs contribute to the development of extreme phenotypes of female BRCA1/2 PV carriers with respect to age at primary BC diagnosis. Construction of optimized PRS SNP sets for BC risk stratification in BRCA1/2 PV carriers should be the task of future studies with larger, well-defined study samples. Furthermore, our results provide further evidence, that localization of PVs in BC/OC cluster regions might be considered in BC risk calculations for unaffected BRCA1/2 PV carriers.

PMID:35761208 | DOI:10.1186/s12885-022-09780-1

JMIR Aging. 2022 Jun 27. doi: 10.2196/39386. Online ahead of print.

ABSTRACT

BACKGROUND: One of the toughest decisions frequently faced by frail elders is to remain at home, with or without assistance, or move into residential care. Frail elders and caregivers need support from their home care teams in making this difficult housing decision. However, home care teams are often understaffed, and busy, shared decision-making (SDM) training is costly, and overall awareness of SDM is increasing. We hypothesized that, distributing a decision aid could be sufficient for providing decision support without the addition of SDM training for home care teams.

OBJECTIVE: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making (IP-SDM) to passive dissemination of a decision guide on the proportion of frail elders or caregivers of cognitively-impaired frail elders reporting active roles in housing decision-making.

METHODS: We conducted a stepped-wedge cluster randomized trial with home care teams in nine health centers in Quebec, Canada. Participants were frail elders or caregivers of cognitively-impaired frail elders facing housing decisions and receiving care from a home care team of one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for home care teams plus a 3.5-hour interactive workshop in interprofessional SDM using a decision guide, designed to support frail elders and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making, among frail elders and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail elders and caregivers in decision-making. We performed intention-to-treat analysis.

RESULTS: A total of 311 frail elders were included in the analysis: (208 [66.9%] female; mean [SD] age, 81.2[7.5] years; 183 [58.8%] secondary school level or higher) and 339 caregivers of cognitively-impaired frail elders (239 [70.5%] female; mean age, 66.4[11.7] years; 269 [87.3%] secondary school level or higher). After adjusting for clustering, time effects and prespecified covariates, the intervention increased the proportion of frail elders reporting active roles in decision-making by 3.3% (95% CI -5.8% to 12.4%; P=.47) and the proportion of caregivers of cognitively-impaired frail elders by 6.1% (95% CI -11.2% to 23.4%; P=.49). There was no significant impact on secondary outcomes. However, the mean score of frail elders’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI – 0.6 to 11.4); P= .07 and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI – 16.5% to 1.6%); P= .10.

CONCLUSIONS: Although it slightly reduced decisional conflict for caregivers, SDM training did not equip home care teams significantly better than provision of a decision aid for involving frail elders and their caregivers in decision-making.

CLINICALTRIAL: Trial Registration ClinicalTrials.gov identifier: NCT02592525.

PMID:35759791 | DOI:10.2196/39386