Tag: pubmed

PLoS One. 2024 Nov 1;19(11):e0298996. doi: 10.1371/journal.pone.0298996. eCollection 2024.

ABSTRACT

BACKGROUND: Breast cancer is a global concern, with 2.3 million new cases and 685,000 deaths recorded in 2020, and projections of reaching 4.4 million cases by 2070. In Tanzania, it’s the second leading cause of cancer-related deaths among women, often diagnosed at advanced stages, leading to poor outcomes. Only 5% of women in the country report undergoing breast cancer screening, the aim study is to determine factors associated with breast cancer screening in Tanzania.

METHODS: This was analytical cross-sectional study among women of reproductive age in Tanzania, utilizing data from the Demographic and Health Surveys (DHS) which employed a two-stage probability sampling. A weighted sample of 15,189 women of reproductive age (15-49) was included in the study. Binary logistic regression analysis was used to examine factors associated with breast cancer screening. These results were presented using adjusted odds ratio (AOR) with a 95% confidence interval.

RESULTS: After controlling for other factors, the following factors remained significantly associated with breast cancer screening among women of reproductive age; age(AOR = 5.33, 95% CI 3.72, 7.63), being wealthy (AOR = 2.34, 95% CI 1.61, 3.38), residing in rural(AOR = 0.59, 95% CI 0.46, 0.763), being educated(AOR = 2.43, 95% CI 1.60, 3.68), being insured(AOR = 2.40, 95% CI 1.89, 3.06), healthcare facility visits in the past 12 months(AOR = 1.43, 95% CI 1.14, 1.78) and living in Northern zone (AOR = 2.43, 95% CI 1.42, 4.15) compared to western zone.

CONCLUSION: Breast cancer screening is still under-utilized and have shown to be marginalized in women of reproductive age. Upgrading diagnostic services, comprehensive health education and awareness campaigns are instrumental to increase utilization and reduction of burden of breast cancers in Tanzania.

PMID:39485789 | DOI:10.1371/journal.pone.0298996

PLoS One. 2024 Nov 1;19(11):e0288888. doi: 10.1371/journal.pone.0288888. eCollection 2024.

ABSTRACT

BACKGROUND: Surgery is an indispensable component of a functional healthcare system. To date there is limited information regarding how many people die during the perioperative period globally. This study describes a protocol for a systematic review and multilevel meta-regression to evaluate time trends regarding the odds of perioperative mortality among adults undergoing a bellwether surgical procedure while accounting for higher order clustering at the national level.

METHODS: Published studies reporting the number of perioperative deaths from bellwether surgical procedures among adults will be identified from MEDLINE, Embase, Cochrane CENTRAL, LILACS and Global Index Medicus. The primary outcome will be the rate of perioperative mortality across time and the secondary outcome will be investigating cause of death over time as a proportion of overall perioperative mortality. Two reviewers will independently conduct full text screening and extract the data. Disagreements will first be resolved via consensus. If consensus cannot be reached a third reviewer will be included to arbitrate. Due to human resource limitations, a risk of bias appraisal will not be conducted. From the included studies a multilevel meta-regression will be constructed to synthesize the results. This model will conceptualize patients as nested in studies which are in turn nested within countries while taking into account potential confounding variables at all levels.

DISCUSSION: The systematic review and multilevel meta-regression that will be conducted based on this protocol will provide synthesized global evidence regarding the trends of perioperative mortality. This eventual study may help policymakers and other key stakeholders with benchmarking surgical safety initiatives as well as identify key gaps in our current understanding of global perioperative mortality.

TRIAL REGISTRATION: Systematic review registration: PROSPERO registration number 429040.

PMID:39485783 | DOI:10.1371/journal.pone.0288888

PLoS One. 2024 Nov 1;19(11):e0311909. doi: 10.1371/journal.pone.0311909. eCollection 2024.

ABSTRACT

BACKGROUND: Numerous studies indicated that workers in the health sector suffer from work stress, hassles, and mental health problems associated with COVID-19, which negatively affect the completion of their job tasks. These studies pointed out the need to search for mechanisms that enable workers to cope with job stress effectively.

OBJECTIVES: This study investigated psychological flow, mental immunity, and job performance levels among the mental health workforce in Saudi Arabia. It also tried to reveal the psychological flow (PF) and mental immunity (MI) predictability of job performance (JP).

METHOD: A correlational survey design was employed. The study sample consisted of 120 mental health care practitioners (therapists, psychologists, counselors)who lived in Saudi Arabia. Sixty-four were men, 56 were women, and their ages ranged between 27 and 48 (36.32±6.43). The researchers developed three measurements of psychological flow, mental immunity, and job performance. After testing their validity and reliability, these measures were applied to the study participants.

RESULTS: The results found median levels of psychological flow, mental immunity, and job performance among mental health care practitioners. Also, the results revealed that psychological flow and mental immunity were statistically significant predictors of job performance. The psychological flow variable contributed (38.70%) and mental immunity (54.80%) to the variance in job performance of mental health care practitioners.

CONCLUSION: The current study indicated that psychological flow and mental immunity significantly influenced the job performance of mental health care practitioners. These findings pointed out that human resource management in mental health care institutions in Saudi Arabia must search for procedures that achieve a state of flow and mental immunity for workers to make their jobs more meaningful. Also, these findings indicated the importance of planning interventions to enhance mental health care practitioners’ psychological flow, mental immunity, and job performance to help them cope with work stress effectively and protect them from symptoms of burnout.

PMID:39485778 | DOI:10.1371/journal.pone.0311909

PLoS One. 2024 Nov 1;19(11):e0308628. doi: 10.1371/journal.pone.0308628. eCollection 2024.

ABSTRACT

Meta-analysis is a statistical technique that combines the results of different environmental experiments regarding the populations, location, time, and so on. These results will differ more than the within-study variance, and the true effects being evaluated differ between studies. Thus, heterogeneity is present and should be measured. There are different estimators that were introduced to estimate between-study variance, which has received a lot of criticism from previous researchers. All of the estimators encountered the same problem, which was the correlation. To minimize the potential biases caused by interventions between the three estimators (i.e., overall effect size, within-study variance, and between-study variance), we proposed a new measure of heterogeneity known as the Environmental Effect Ratio (EER), the treatment-by-lab variability relative to the experimental error, under individual participant data (IPD) using the linear mixed model approach. We assume different between-study variances instead of constant between-study variances. The simulation of this study focuses on the performance of meta-analyses with small sample sizes. We compared our proposed estimator under two different expressions ([Formula: see text], and [Formula: see text]) with the best estimator nominated from previous studies to determine which one is the best performance. Based on the findings, our estimator ([Formula: see text]) was better for estimating between-study variance.

PMID:39485777 | DOI:10.1371/journal.pone.0308628

PLoS One. 2024 Nov 1;19(11):e0311901. doi: 10.1371/journal.pone.0311901. eCollection 2024.

ABSTRACT

BACKGROUND: Access to and use of urgent and emergency care in the United Kingdom’s National Health Service reduced during COVID-19 related lockdowns but demand reportedly increased since then. We investigated the impact of COVID-19 on urgent and emergency health care services activity in an eastern England population of 1.1 million.

METHODS: We used health care activity data from a municipal health department, recorded at the level of discrete events (such as visits to hospital or ambulance calls) to compare system activity between 2018-2020 (pre-COVID), 2020-2021 (lockdown) and 2021-2023 (post-lockdown), carrying out interrupted time series analyses to describe changes in activity.

RESULTS: Daily emergency department (ED) attendances were 10% (95% confidence interval 9-12%) lower during the lockdown period, and 7% (6-8%) higher in the post-lockdown period than pre-COVID. Attendances arriving by ambulance were 13% (12-14%) lower post-lockdown than pre-COVID, while attendances of arrivals by other means were 17% (16-19%) higher. Post-lockdown, overall attendances were continually reducing. ED waiting times were 45% (44-47%) longer in the post-lockdown period compared to the pre-COVID period and continued to increase post-lockdown. There was a 15% (14-16%) reduction in daily ambulance dispatches post-lockdown versus pre-COVID. Ambulance arrivals with delayed handover to hospital care exceeding 60 minutes increased by 17% (16-18%) post-lockdown versus pre-COVID, and probability of delay showed a continuously upward trend post-lockdown of 20% (19-21%) per year.

CONCLUSION: Patients are facing long waits in EDs to be admitted to hospital, discharged or transferred. This results in delays in ambulances handing over patients and attending to other calls, which may explain decreasing rates of ambulance dispatches. Potential solutions are likely to involve enhancing the flow through and discharge of patients from hospital, and a whole systems approach which considers the capacity of the local health and care infrastructure, including intermediate care and social care.

PMID:39485775 | DOI:10.1371/journal.pone.0311901

Nucleosides Nucleotides Nucleic Acids. 2024 Nov 1:1-10. doi: 10.1080/15257770.2024.2421302. Online ahead of print.

ABSTRACT

Osteoporosis is a common age-related skeletal disease, characterized by changes in the microarchitectural structure of bone tissue and decreased bone mass, especially affecting postmenopausal women. Genetic and environmental factors affecting bone metabolism play a role in the development of osteoporosis. Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme involved in the conversion of homocysteine to methionine. Genetic variations in the MTHFR gene lead to impaired function or inactivation of this enzyme. A decrease in MTHFR enzyme activity and an increase in homocysteine levels affect bone metabolism. In this study, we aimed to investigate the relationship between C677T and A1298C polymorphisms and osteoporosis in Turkish postmenopausal women. DNA samples were extracted from 200 volunteers. The PCR-RFLP technique was used to identify the MTHFR gene polymorphisms C677T and A1298C. The statistical significance of the analysis’s results was assessed. C677T genotype and allele frequency distributions were not statistically different between postmenopausal osteoporosis and healthy control groups (p = 0.249, p = 0.754), while A1298C genotype and allele frequency distributions were found to be statistically significant (p = 0.002, p = 0.013). The results of our study showed that the A1298C polymorphism may be a genetic factor associated with osteoporosis in this specific population. However, the C677T polymorphism did not show a significant connection. To gain a more comprehensive understanding of the genetic basis of osteoporosis, future research with larger sample sizes and the consideration of additional genetic and environmental factors is essential. Additionally, it is crucial to account for ethnic disparities, gene-gene interactions, and gene-environment interplays. These insights can inform the development of personalized preventive and therapeutic strategies for individuals at risk of osteoporosis in diverse populations.

PMID:39485384 | DOI:10.1080/15257770.2024.2421302

Elife. 2024 Nov 1;12:RP92854. doi: 10.7554/eLife.92854.

ABSTRACT

Interactions between excitatory and inhibitory neurons are critical to computations in cortical circuits but their organization is difficult to assess with standard electrophysiological approaches. Within the medial entorhinal cortex, representation of location by grid and other spatial cells involves circuits in layer 2 in which excitatory stellate cells interact with each other via inhibitory parvalbumin expressing interneurons. Whether this connectivity is structured to support local circuit computations is unclear. Here, we introduce strategies to address the functional organization of excitatory-inhibitory interactions using crossed Cre- and Flp-driver mouse lines to direct targeted presynaptic optogenetic activation and postsynaptic cell identification. We then use simultaneous patch-clamp recordings from postsynaptic neurons to assess their shared input from optically activated presynaptic populations. We find that extensive axonal projections support spatially organized connectivity between stellate cells and parvalbumin interneurons, such that direct connections are often, but not always, shared by nearby neurons, whereas multisynaptic interactions coordinate inputs to neurons with greater spatial separation. We suggest that direct excitatory-inhibitory synaptic interactions may operate at the scale of grid cell clusters, with local modules defined by excitatory-inhibitory connectivity, while indirect interactions may coordinate activity at the scale of grid cell modules.

PMID:39485383 | DOI:10.7554/eLife.92854

JAMA Netw Open. 2024 Nov 4;7(11):e2442154. doi: 10.1001/jamanetworkopen.2024.42154.

ABSTRACT

IMPORTANCE: High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown.

OBJECTIVE: To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024.

EXPOSURE: EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness).

MAIN OUTCOMES AND MEASURES: Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness.

RESULTS: A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year.

CONCLUSIONS AND RELEVANCE: In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children’s lives each year.

PMID:39485354 | DOI:10.1001/jamanetworkopen.2024.42154

JAMA Netw Open. 2024 Nov 4;7(11):e2442163. doi: 10.1001/jamanetworkopen.2024.42163.

ABSTRACT

IMPORTANCE: Meal timing strategies, such as time-restricted eating (TRE), reducing meal frequency, or altering calorie distribution across the day, have gained interest for their potential to enhance weight loss and metabolic health, particularly in managing chronic diseases, yet their long-term benefits are not known.

OBJECTIVE: To evaluate the association between meal timing strategies (≥12 weeks) and anthropometric and metabolic indicators.

DATA SOURCES: Medline, Embase, CINAHL, and Cochrane CENTRAL were searched from inception to October 17, 2023.

STUDY SELECTION: Randomized clinical trials, regardless of language and publication date, involving adults 18 years and older, evaluating within-day meal timing patterns for 12 or more weeks, and reporting anthropometric measures were included. Studies were excluded if participants had eating disorders, prior significant weight change, underwent bariatric surgery, were pregnant, or if controlled variables differed between groups.

DATA EXTRACTION AND SYNTHESIS: Study quality was determined via Risk of Bias 2.0 tool. Data were extracted independently by multiple reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used. Meta-analysis was performed using random-effects model on pooled continuous outcomes with 2 or more studies.

MAIN OUTCOME AND MEASURES: Weight change in kilograms, reported as between-group mean difference with 95% CIs.

RESULTS: Sixty-nine reports of 29 randomized clinical trials including 2485 individuals (1703 [69%] female; mean [SD] age, 44 [9.5] years; and mean [SD] body mass index, 33 [3.5]) were included. Study interventions included TRE (17 studies), meal frequency (8 studies), and calorie distribution (4 studies). There were some concerns of risk of bias for 7 studies and high concerns for 22 studies. Statistically significant weight change was observed in TRE when compared with control (-1.37 kg; 95% CI, -1.99 to -0.75 kg). Lower meal frequency and earlier caloric distribution were also both associated with greater change (-1.85 kg; 95% CI, -3.55 to -0.13 kg; and -1.75 kg; 95% CI, -2.37 to -1.13 kg, respectively).

CONCLUSIONS AND RELEVANCE: The findings of this meta-analysis suggest that TRE, lower meal frequency, and earlier caloric distribution in the day may reduce weight compared with standard care and/or nutritional advice; however, the effect sizes found were small and of uncertain clinical importance. High heterogeneity and risk of bias among included studies led to concerns about the certainty of the underpinning evidence. Further research, including trials with larger sample sizes, standardized interventions with prescribed or matched energy intake, and longer follow-up, are needed.

PMID:39485353 | DOI:10.1001/jamanetworkopen.2024.42163

JAMA Netw Open. 2024 Nov 4;7(11):e2442361. doi: 10.1001/jamanetworkopen.2024.42361.

ABSTRACT

IMPORTANCE: In patients with acute myocardial infarction (MI), limited physiologic adaptation to acute anemia might lead to greater benefit from a liberal red blood cell (RBC) transfusion strategy. Data on such a possible benefit are lacking.

OBJECTIVES: To compare acute anemia with chronic anemia and post-MI outcomes and estimate the differential effect of a restrictive RBC transfusion strategy compared with a liberal strategy on post-MI outcomes according to anemia acuity.

DESIGN, SETTING, AND PARTICIPANTS: A prespecified subgroup analysis of the Myocardial Ischemia and Transfusion (MINT) multicenter randomized clinical trial was conducted in 126 hospitals in 6 countries between April 26, 2017, and April 14, 2023, with 30-day follow-up and blinded adjudication of the primary outcome. The analysis included 3144 of 3504 MINT participants (89.7%) with acute MI, a hemoglobin (Hb) level less than 10 g/dL at randomization, and a first Hb measurement available on the day of or the day following hospital admission.

INTERVENTION: The MINT trial randomized participants to a restrictive (Hb <7-8 g/dL) or liberal (Hb <10 g/dL) RBC transfusion strategy. Acute anemia was defined as having a first Hb value greater than 13 g/dL (men) or 12 g/dL (women), or as having a decrease greater than or equal to 2 g/dL between the first Hb measurement and measurement at randomization. Other Hb levels were categorized as chronic anemia.

MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death or recurrent MI up to 30 days after randomization. Secondary outcomes were death, recurrent MI, cardiac death, heart failure, pulmonary complications, and major bleeding events. Intention-to-treat analysis was performed.

RESULTS: Among 3144 included participants (mean [SD] age, 72.3 [11.6] years; 1715 [54.5%] male; 1307 [41.6%] with type 1 MI), 1078 [34.3%]) had acute anemia. Acute anemia was associated with an increased risk of death or recurrent MI (adjusted risk ratio, 1.25; 95% CI, 1.05-1.48). The effect of a restrictive RBC transfusion strategy compared with a liberal strategy was similar for participants with either acute or chronic anemia for all outcomes.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of the MINT trial, acute anemia was associated with less favorable post-MI outcomes than chronic anemia but did not modify the effects of the randomized transfusion strategy. In patients with anemia and MI, the acuity of anemia should not influence the choice of transfusion trigger.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02981407.

PMID:39485351 | DOI:10.1001/jamanetworkopen.2024.42361