Tag: pubmed

J Public Health (Oxf). 2022 Nov 3:fdac122. doi: 10.1093/pubmed/fdac122. Online ahead of print.

ABSTRACT

BACKGROUND: Differential attainment has been widely observed in United Kingdom (UK) medical training, with minority ethnicity being associated with reduced success in recruitment and progression through training. Specialty training in Public Health in the UK recruits candidates with medical as well as non-medical backgrounds. At the request of the UK Faculty of Public Health and Health Education England, we sought to examine whether differential attainment may or may not be occurring in the multi-stage recruitment process.

METHODS: We analysed 3 years of national recruitment data into Public Health specialty training to identify whether demographic characteristics including age, sex, ethnicity and professional background were associated with successful recruitment.

RESULTS: In total 2252 applications between 2018 and 2020 were analysed. Candidates who were older, Asian, black or from backgrounds other than medicine were significantly less likely to progress from the psychometric testing stage than the white British group. Fewer statistically significant differences were observed at the final stage of recruitment involving interviews, group work and a written task.

CONCLUSIONS: The findings suggest that older candidates those from some ethnic minority backgrounds and those from backgrounds other than medicine are disadvantaged by the current recruitment process, with differential attainment associated with the psychometric testing stage.

PMID:36335426 | DOI:10.1093/pubmed/fdac122

Allergy Asthma Proc. 2022 Nov 1;43(6):543-545. doi: 10.2500/aap.2022.43.220067.

ABSTRACT

Background: Curcumin has been shown to decrease allergic symptoms and biomarkers in some animal and human studies. Objective: Our study aimed to determine if curcumin affects immediate skin-prick testing. Methods: We enrolled 34 participants sensitized to select antigens. The participants were randomized to treatment with curcumin or placebo in a double-blind fashion. The participants underwent titrated skin-prick testing before and after 1 week of treatment, and the pre- and posttreatment skin test wheals and flares were compared. Results: Curcumin did not have a statistically significant effect on immediate skin-prick test wheal or flare size. Conclusion: Although curcumin may attenuate allergic symptoms and biomarkers, it does not have a significant effect on immediate skin-prick test results and does not need to be discontinued before testing.

PMID:36335415 | DOI:10.2500/aap.2022.43.220067

Trials. 2022 Nov 5;23(1):924. doi: 10.1186/s13063-022-06790-z.

ABSTRACT

BACKGROUND: The HemiSPAIRE trial is being conducted to determine whether a modified muscle sparing technique (SPAIRE-“Save Piriformis and Internus, Repairing Externus”) in hip hemiarthroplasty brings clinical benefits compared to the standard lateral technique in adults aged 60 years or older, with a displaced intracapsular hip fracture. This article describes the detailed statistical analysis plan for the trial. METHODS AND DESIGN: HemiSPAIRE is a definitive, pragmatic, superiority, multicentre, randomised controlled trial (with internal pilot) with two parallel groups. Participants, ward staff and all research staff involved in post-operative assessments are blinded to allocation. This article describes in detail (1) the primary and secondary outcomes; (2) the statistical analysis principles, including a survivor average causal effect (SACE) method chosen specifically to address the issue of potential bias from differential survival between trial arms, which was seen from data review by the Trial Steering Committee, the participants that will be included in each analysis, the covariates that will be included in each analysis, and how the results will be presented; (3) planned main analysis of the primary outcome; (4) planned analyses of the secondary outcomes; and (5) planned additional analyses of the primary and secondary outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04095611. Registered on 19 September 2019.

PMID:36335403 | DOI:10.1186/s13063-022-06790-z

Addict Sci Clin Pract. 2022 Nov 5;17(1):60. doi: 10.1186/s13722-022-00342-1.

ABSTRACT

BACKGROUND: Medication for opioid use disorder (MOUD) reduces mortality, but few patients access MOUD. At a Federally Qualified Health Center (FQHC), we implemented a low barrier model of MOUD, including same-day MOUD initiation and a harm reduction philosophy.

OBJECTIVE: To investigate whether low barrier MOUD improved retention in care compared to traditional treatment.

DESIGN AND PARTICIPANTS: Retrospective cohort study of patients with at least one visit seeking MOUD at the FQHC during a historical control period (3/1/2018-3/31/2019) and a low barrier intervention period (11/1/2019-7/31/2020).

MAIN MEASURES: Primary outcomes were any MOUD prescription within 6 months of the index visit and 3- and 6-month retention in treatment without care gap, with care gap defined as 60 consecutive days without a visit or prescription. Secondary outcomes were all-cause hospitalization and emergency department visit within 6 months of the index visit.

KEY RESULTS: Baseline characteristics were similar between the intervention (n = 113) and control (n = 90) groups, except the intervention group had higher rates of uninsured, public insurance and diabetes. Any MOUD prescription within 6 months of index visit was higher in the intervention group (97.3% vs 70%), with higher adjusted odds of MOUD prescription (OR = 4.01, 95% CI 2.08-7.71). Retention in care was similar between groups at 3 months (61.9% vs 60%, aOR = 1.06, 95% CI 0.78-1.44). At 6 months, a higher proportion of the intervention group was retained in care, but the difference was not statistically significant (53.1% vs 45.6%, aOR 1.27, 95% CI 0.93-1.73). There was no significant difference in adjusted odds of 6-month hospitalization or ED visit between groups.

CONCLUSIONS: Low barrier MOUD engaged a higher risk population and did not result in any statistically significant difference in retention in care compared with a historical control. Future research should determine what interventions improve retention of patients engaged through low barrier care. Primary care clinics can implement low barrier treatment to make MOUD accessible to a broader population.

PMID:36335381 | DOI:10.1186/s13722-022-00342-1

Pilot Feasibility Stud. 2022 Nov 5;8(1):237. doi: 10.1186/s40814-022-01192-z.

ABSTRACT

INTRODUCTION: Postoperative infections represent a significant burden of disease, demanding antibiotic prescriptions, and are contributing to antimicrobial resistance. The burden of infection as a surgical complication is greater in low- and middle-income countries (LMICs). We report the protocol of a pilot study for the co-design, implementation and evaluation of two infection prevention and control (IPC) and antimicrobial stewardship (AMS) interventions across the surgical pathway in a teaching hospital in India.

METHODS AND ANALYSIS: The two interventions developed following in-depth qualitative enquiry are (i) surveillance and feedback of postoperative infections to optimise the use of antibiotics in two surgical departments (gastrointestinal and cardiovascular and thoracic surgery) and (ii) raising awareness amongst patients, carers and members of public about IPC and AMS. We will conduct a prospective study, formatively evaluating the implementation process of delivering the two co-designed interventions using implementation science frameworks. The study will systematically assess the context of intervention delivery, so that implementation support for the interventions may be adapted to the needs of stakeholders throughout the study. Analysis of implementation logs and interviews with stakeholders upon completion of the implementation period, will offer insights into the perceived acceptability, appropriateness, feasibility and sustainability of the interventions and their implementation support. Implementation costs will be captured descriptively. Feasibility of clinical data collection to investigate effectiveness of interventions will also be assessed for a future larger study. Thematic framework analysis and descriptive statistics will be used to report the qualitative and quantitative data, respectively.

STRENGTHS AND LIMITATIONS OF THIS STUDY: • The paired interventions have been co-designed from their inception with involvement of stakeholders at different stages in the surgical pathway. • Simultaneous evaluation of implementation and clinical outcomes will inform the development of a future larger study to enable/assess the scalability of interventions • The study offers a novel combination of implementation theory-informed, stakeholder-driven and clinically relevant evaluation, carried out in the context of a middle-income country hospital. • The project may not be applicable to every low-resource setting and surgical context due to differences in healthcare systems and cultures. However, the application of implementation science concepts may facilitate transferability and adaptation to other settings.

PMID:36335367 | DOI:10.1186/s40814-022-01192-z

BMC Public Health. 2022 Nov 5;22(1):2027. doi: 10.1186/s12889-022-14392-2.

ABSTRACT

BACKGROUND: It is difficult to accurately assess the health literacy(HL) level of Mongolians by using Chinese conventional HL questionnaire, due to their particularity in language, culture and living environment. Therefore, it is very important to design an exclusive HL questionnaire for them. In addition, the existing statistical models cannot meet the requirement of HL assessment with high precision, so it is necessary to study a new HL assessment model.

METHODS: A HL questionnaire with 68 questions is designed by combing the HLS-EU-Q47and the characteristics of Mongolians in China. 742 Mongolians aged 18 to 87 in Inner Mongolia of China answered the questionnaire. A data set with 742 samples is constructed, where each sample has 68 features and 1 target. Based on it, the XGB and LGBM regression models are respectively constructed to assess the HL levels of respondents, and their evaluation effects are compared. The impact of each question on the HL level is quantitatively analyzed by using the feature-importance function in LGBM model to verify the effectiveness of the questionnaire and to find the key factors for affecting HL.

RESULTS: The HL questionnaire has the high reliability, which is reflected by the high internal consistency (Cronbach’s coefficient=0.807) and test-retest reliability (Mutual Information Score= 0.803). The validity of the HL questionnaire is obtained by solving KMO and Bartlett Spherical Test Chi-square Value, which are 0.765 and 2486 ([Formula: see text]), respectively. [Formula: see text] index and the absolute error obtained by using the HL assessment model based on LGBM are 0.98347 and 11, which are better than ones by applying the model based-XGB, respectively. The quantitative analysis results show that all 68 questions have influence on HL level, but their degree are different. The first three factors are age, salary level, the judgment ability for the HL information in media, respectively. The HL level distribution of the respondents was 66.71[Formula: see text] excellent, 25.74[Formula: see text] good and 7.54[Formula: see text] poor, respectively.

CONCLUSIONS: The presented HL questionnaire with 68 questions and LGBM regression model can obtain the HL level assessment results with high precision for Mongolians in China. The impact of each question in the questionnaire on the final assessment results can be quantified by using the feature-importance function in LGBM model, which is better than the existing qualitative analysis methods.

PMID:36335364 | DOI:10.1186/s12889-022-14392-2

J Orthop Surg Res. 2022 Nov 5;17(1):481. doi: 10.1186/s13018-022-03360-6.

ABSTRACT

BACKGROUND: The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance.

METHODS: Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant.

RESULTS: A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up.

CONCLUSION: Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.

PMID:36335350 | DOI:10.1186/s13018-022-03360-6

BMC Musculoskelet Disord. 2022 Nov 5;23(1):958. doi: 10.1186/s12891-022-05759-y.

ABSTRACT

BACKGROUND: The total hip arthroplasty (THA) has gained popularity in in the treatment of severe developmental dysplasia of the hip (DDH). the posterior lateral approach (PLA) has good clinical efficacy and has been confirmed by the majority clinicians. Nevertheless, controversy exists regarding longer-term benefits of the direct anterior approach (DAA). The objective of this study was to investigate the clinical efficacy and placement of S-ROM prosthesis in the treatment of severe DDH by The total hip arthroplasty (THA) with different surgical approaches.

METHODS: A retrospective analysis was performed on 42 patients with severe DDH admitted to our hospital from August 2015 to February 2022, who were treated with S-ROM prosthesis for total hip arthroplasty and subtrochanteric osteotomy of the femur. They were divided into DAA group and PLA group according to different surgical approaches. Perioperative indicators and imaging data were collected.

RESULTS: The surgery time, intraoperative blood loss, and creatine kinase difference in DAA group and PLA group was without a statistically significant difference (P > 0.05). The postoperative length of hospitalization was shorter in the DAA group than in the PLA group (6.50 ± 3.15 vs 9.18 ± 4.93, P = 0.045). The acetabular abduction angles、the acetabular anteversion angles, the safe area ratio, The difference of femoral eccentricity, and the vertical difference of rotation center in DAA group and PLA group, there was no statistical significance (P > 0.05). Statistically significant differences were detected the horizontal difference of rotation center (P = 0.044).

CONCLUSIONS: Total hip arthroplasty with S-ROM prosthesis is a feasible procedure for severe dysplastic DDH. The clinical efficacy and prosthesis placement parameters of DAA approach are advantage to those of PLA approach.

PMID:36335347 | DOI:10.1186/s12891-022-05759-y

BMC Public Health. 2022 Nov 5;22(1):2028. doi: 10.1186/s12889-022-14460-7.

ABSTRACT

BACKGROUND: The overall aim of this study was to examine essential aspects of reliability and validity of a constructed Occupational Mechanical Job Exposure Index for use in analyses of Norwegian register data. METHODS: We utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006, 2009, 2013, 2016 and 2019. Occupations were classified on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). We constructed a 4-digit correspondence table between the occupational codes used in the 2006 and 2009 surveys (STYRK-98) and the codes used in 2013, 2016 and 2019 (STYRK-08). The mechanical exposures were collected by Statistics Norway using telephone interviews. As for reliability, we examined the agreement between the individual- and the occupational-based mechanical exposures using Cohen’s kappa, sensitivity and specificity measures. Construct, concurrent and predictive validity pertaining to the Occupational Mechanical Job Exposure Index were analysed using both survey data and nationwide register data.

RESULTS: The analysis shows a fair-to-moderate overlap between occupational-based mechanical exposures and the individually reported exposures. Construct validity of the Occupational Mechanical Job Exposure Index, as estimated by a confirmatory factor analysis using the occupational-based mechanical exposures, showed that the 8 exposures formed one underlying factor. When assessing the concurrent value of the Occupational Mechanical Job Exposure Index to the index based on the individual reported exposures, the occupational mechanical index showed lower and reproducible associations with lower back pain for both men and women. For long-term sick leave, the occupational mechanical index showed higher and reproducible associations for both genders. As for predictive validity, the register data analysis shows that the occupational mechanical index was associated with disability and a higher number of long-term sickness benefits periods for both men and women. For men the index also predicted higher mortality.

CONCLUSION: Our tests of reliability and validity of the Occupational Mechanical Job Exposure Index indicate that the index overall has acceptable statistical properties and will be useful in analyses of Norwegian register data where individual information on these types of exposures is missing.

PMID:36335343 | DOI:10.1186/s12889-022-14460-7

BMC Surg. 2022 Nov 5;22(1):380. doi: 10.1186/s12893-022-01817-3.

ABSTRACT

BACKGROUND: Seventy percent of ureteric injuries result from iatrogenic causes with about 75% of these diagnosed in the postoperative period. It may have fatal complications such as sepsis and or renal functional damage increasing morbidity and treatment cost.

OBJECTIVE: The study aimed to identify the risk factors for iatrogenic ureteric injuries from open surgical procedures and the intervention outcome in a resource-poor setting.

PATIENTS AND METHODS: This was a multi-centre study. The clinical records of patients with iatrogenic ureteric injuries seen between 2015-2021 who were managed at the urology units of the Margaret Marquart Catholic Hospital, and the Ho Teaching Hospital, in the Volta region of Ghana, were retrieved. The data extracted included patients’ demographic factors, the clinical presentation, the primary surgery details, the time from surgery to presentation, the intervention offered, and the outcomes. The data were analysed using the Statistical Package for Social Scientists (SPSS) version 24.0.

RESULTS: Twelve patients aged between 24-54 years with a total of 19 ureteric injuries were managed. The injuries resulted from a hysterectomy in 10 cases (83.3%), and one each from emergency caesarean section and inguinal hernia repair with traction and transection injuries respectively (16.7%). Seven out of 12 cases were diagnosed 48 h after surgery. Bilateral injuries occurred in 7 cases (14/19 injuries). Intraoperative recognition was common in unilateral injuries and surgeries performed by specialist surgeons. Ureteroneocystostomy (14/19), uretero-ureterostomy (1/19), and open suture release were the management procedures performed as in the intervention.

CONCLUSION: Open hysterectomy (83.7%) was the most common procedure leading to iatrogenic ureteric injuries in this study. Intra-operative recognition occurred when trained specialist surgeons performed the surgery. Late presentation with more severe morbidity was found amongst non-specialist surgeons. Thus, improvement in training to allow intra-operative diagnosis should be encouraged in general practitioners to reduce morbidity and improve outcomes.

PMID:36335342 | DOI:10.1186/s12893-022-01817-3