Tag: statistics

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S176-S183. doi: 10.3855/jidc.19243.

ABSTRACT

INTRODUCTION: The use of telemedicine for treatment of coronavirus disease 2019 (COVID-19) infection has been effective in lowering the risk of infection and relieving strain on the healthcare system. This study aimed to describe the clinical characteristics of COVID-19 cases, their follow-up, risk factors of disease severity, and predictors of hospital admission while using telemedicine.

METHODOLOGY: The study included 611 Egyptian patients with mild and moderate COVID-19 disease. The patients were isolated at home and monitored daily.

RESULTS: Based on the World Health Organization classification, 79% of studied patients had mild illness while 20.5% had moderate illness. The initial symptoms included cough (51.7%), fever (50.8%), fatigue (45.9%), sore throat (41.1%), dyspnea (35.2%), and headache (34%); 25.2% patients had prolonged symptoms (≥ 21 days). Dyspnea was the most frequent (15.5%) long-term symptom. Age, co-existing diabetes, and COVID-19 infection with moderate severity, were associated with the need for hospitalization. We compared patients with COVID-19 infection who required hospital admission (n = 37) versus patients who continued in home isolation (n = 574). High neutrophil/lymphocyte ratio, transaminases, and ferritin significantly correlated with the need for hospitalization. 18.9% of the patients who required hospital admission had diabetes. Multivariate analysis described age and diabetes as independent predictors of disease severity. Age and high neutrophil/lymphocyte ratio were independent predictors of hospital admission.

CONCLUSIONS: Telemedicine is effective in-home management of mild/moderate COVID-19 patients, which may ease the pressure on the healthcare system, even beyond the pandemic.

PMID:39499762 | DOI:10.3855/jidc.19243

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S153-S162. doi: 10.3855/jidc.18620.

ABSTRACT

INTRODUCTION: Urethral catheterization is commonly required in coronavirus disease 2019 (COVID-19) patients hospitalized in intensive care units (ICUs). However, this increases their vulnerability to nosocomial infections such as catheter-associated urinary tract infections (CAUTIs). Existing studies on nosocomial infections in COVID-19 patients usually report CAUTI prevalence but neglect the clinical differences between CAUTI and non-CAUTI patients. This study aimed to assess clinical features, microbiological characteristics, and outcomes of COVID-19 patients with CAUTI vs non-CAUTI patients in an ICU.

METHODOLOGY: We analyzed the clinical data from a retrospective cohort study of 527 critically ill COVID-19 patients who required urethral catheterization at the ICU of Bach Mai hospital in Ho Chi Minh City, Vietnam, from August to October 2021. A total of 69 patients (n = 37 CAUTI vs n = 32 non-CAUTI) were selected for urine culture, and their clinical features, microbiological characteristics, and outcomes were recorded for analysis.

RESULTS: COVID-19 patients with CAUTI had a higher mortality rate compared to those without CAUTI (p = 0.02). The length of stay in the ICU was 1.4 times longer for CAUTI patients compared to the non-CAUTI group (p = 0.03). Fungi was the most common microbiological cause of UTI in COVID-19 ICU (91.4%), and Pseudomonas aeruginosa was a significant risk factor of CAUTI. P. aeruginosa, number of antibiotics used, and duration of catheterization had a strong association with the patients’ survival time in ICU.

CONCLUSIONS: This study provides a better understanding of CAUTI in COVID-19 patients, thus facilitating their future treatment.

PMID:39499759 | DOI:10.3855/jidc.18620

J Infect Dev Ctries. 2024 Sep 30;18(9.1):S116-S125. doi: 10.3855/jidc.18844.

ABSTRACT

INTRODUCTION: This study aimed to evaluate the antimicrobial resistance rates before and during the coronavirus disease 2019 (COVID-19) pandemic.

METHODOLOGY: 897 positive urine cultures collected from outpatients of all ages between January 1, 2017, and December 31, 2022, were analyzed. The antibiotic susceptibility tests (AST) were analyzed by using an automated VITEK 2 (Biomerieux, Marcy-l`Étoile, France) compact system. AST results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The significance of resistance rates was tested with the Pearson’s Chi-squared test and risk factors of extended-spectrum beta-lactamases (ESBL) positiveness were identified with binary logistic regression.

RESULTS: E. coli (n = 774) and K. pneumoniae (n = 123) were isolated in 86.3% and 13.7% of the patients, respectively. During this period of six years before and during pandemic, the highest resistance rate was found for cefuroxime axetil (49.8%) and the lowest for nitrofuratoin (6.0%). Statistically significant increases in resistance compared to the pre-pandemic period were only determined for cefixime (37.2 vs 46.0%) and ceftriaxone (37.6 vs 46.1%) (p = 0.010). ESBL positivity was the most important factor that statistically increased resistance for all antibiotics (p < 0.001 for all). Being male [OR (95% CI) 1.56 (1.13-2.15)] and presenting to the clinic after the pandemic period [1.4 (1.1-1.8)] were found to increase ESBL positiveness significantly.

CONCLUSIONS: Ceftriaxone and Cefixime resistance rates and ESBL positivity among the uropathogens E. coli and K. pneumoniae increased during the pandemic compared with the pre-pandemic period. ESBL positivity was higher in males.

PMID:39499755 | DOI:10.3855/jidc.18844

Epidemiol Psychiatr Sci. 2024 Nov 5;33:e58. doi: 10.1017/S2045796024000660.

ABSTRACT

AIMS: Exposure to multiple forms of victimisation in childhood (often referred to as poly-victimisation) has lifelong adverse effects, including an elevated risk of early-adulthood psychopathology. However, not all poly-victimised children develop mental health difficulties and identifying what protects them could inform preventive interventions. The present study investigated whether individual-, family- and/or community-level factors were associated with lower levels of general psychopathology at age 18, among children exposed to poly-victimisation. Additionally, it examined whether these factors were specific to poly-victimised children or also associated with fewer mental health difficulties in young adults regardless of whether they had been poly-victimised.

METHODS: We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative cohort of 2,232 children born in 1994-1995 across England and Wales and followed to 18 years of age (with 93% retention, n = 2,066). Poly-victimisation (i.e., exposure to two or more of physical abuse, sexual abuse, emotional abuse and neglect, physical neglect, bullying by peers, and domestic violence) and nine putative protective factors (intelligence quotient, executive functioning, temperament, maternal and sibling warmth, atmosphere at home, maternal monitoring, neighbourhood social cohesion, and presence of a supportive adult) were measured prospectively between ages 5 and 12 years from interviews with mothers and children, surveys of neighbours, child-protection referrals, and researchers’ observations. Early-adulthood psychopathology was assessed in interviews with each twin at age 18 and used to construct a latent factor of general psychopathology.

RESULTS: Approximately a third (n = 720) of participants were prospectively defined as exposed to poly-victimisation (53% male). Poly-victimised children had greater levels of general psychopathology at age 18 than non-poly-victimised children (adjusted [adj.] β = 4.80; 95% confidence interval [95% CI] 3.13, 6.47). Presence of a supportive adult was the only factor robustly associated with lower levels of general psychopathology among poly-victimised children (adj.β = -0.61; 95% CI -0.99, -0.23). However, this association was also evident in the whole sample regardless of poly-victimisation exposure (adj.β = -0.52; 95% CI -0.81, -0.24) and no significant interaction was observed between the presence of a supportive adult and poly-victimisation in relation to age-18 general psychopathology.

CONCLUSIONS: Having at least one adult to turn to for support was found to be associated with less psychopathology in early adulthood among both poly-victimised and non-poly-victimised children. This suggests that strategies to promote better availability and utilisation of supportive adults should be implemented universally. However, it may be beneficial to target these interventions at poly-victimised children, given their higher burden of psychopathology in early adulthood.

PMID:39498630 | DOI:10.1017/S2045796024000660

Epidemiol Psychiatr Sci. 2024 Nov 5;33:e59. doi: 10.1017/S2045796024000696.

ABSTRACT

AIMS: Forcibly displaced people, such as refugees and asylum-seekers (RAS), are at higher risk of mental disorders, mainly post-traumatic stress disorder (PTSD), depression and anxiety. Little is known about the complex relationships between these mental disorders among culturally and linguistically diverse RAS. To investigate this, the present study applied a novel network analytical approach to examine and compare the central and bridge symptoms within and between PTSD, depression and anxiety among Afghan and Syrian RAS in Türkiye.

METHODS: A large-scale online survey study with 785 Afghan and 798 Syrian RAS in Türkiye was conducted in 2021. Symptoms of PTSD (the short form of Post-Traumatic Stress Disorders Checklist [PCL-5]), depression and anxiety (Hopkins Symptoms Checklist-25) [HSCL-25]) were measured via self-administrated validated instruments. We conducted network analysis to identify symptoms that are most strongly connected with other symptoms (central symptoms) and those that connect the symptoms of different disorders (bridge symptoms) in R Studio using the qgraph package.

RESULTS: Overall, Afghans and Syrians differed in terms of network structure, but not in network strength. Results showed that feeling blue, feeling restless and spells of terror or panic were the most central symptoms maintaining the overall symptom structure of common mental disorders among Afghan participants. For Syrian participants, worrying too much, feeling blue and feeling tense were identified as the central symptoms. For both samples, anger and irritability and feeling low in energy acted as a bridge connecting the symptoms of PTSD, depression and anxiety.

CONCLUSION: The current findings provide insights into the interconnectedness within and between the symptoms of common mental disorders and highlight the key symptoms that can be potential targets for psychological interventions for RAS. Addressing these symptoms may aid in tailoring existing evidence-based interventions and enhance their effectiveness. This contributes to reducing the overall mental health burden and improving well-being in this population.

PMID:39498626 | DOI:10.1017/S2045796024000696

J Prim Care Community Health. 2024 Jan-Dec;15:21501319241276780. doi: 10.1177/21501319241276780.

ABSTRACT

OBJECTIVES: Poor Food security (FS) is associated with risk of diet-related diseases and rising healthcare costs. Produce Prescription Interventions (PRx) are emerging clinical tools to improve FS and diet quality, but their impact in families with children is not well established. This study evaluates the impact of a pediatric PRx on FS and nutrition-related behaviors.

METHODS: Adult caregivers of children (0-18) were enrolled within a 6-month produce delivery and nutrition education intervention. A validated food security survey was administered pre/post intervention to determine FS scores and “Food Secure” status. Statistical analyses tested pre-post differences in FS scores and proportion of scores within the “Food Secure” range. Semi-structured interviews were performed post-intervention to explore families’ experiences with low FS and healthy behaviors and were thematically analyzed.

RESULTS: Between October 2021 and December 2022, 82 families were enrolled, 65 completed FS survey at baseline and 54 completed it at post-intervention. FS scores improved post-intervention (P < .05) and a greater proportion of household- and child-level scores fell within the “Food Secure” range post-intervention (P < .05). Twenty-eight interviews were analyzed. Three salient themes were identified: (1) value of healthcare-based screening and intervention, (2) food and education motivate behavior change, and (3) perceptions of post-intervention lifestyle sustainability.

CONCLUSIONS: Participation in the PRx was associated with improvements in FS and nutrition-related attitudes and behaviors. PRx can be implemented by health systems to improve FS and health behaviors associated with risk for diet-related diseases. Longer-term support may be needed to maintain healthy behavior changes associated with PRx participation.

PMID:39498605 | DOI:10.1177/21501319241276780

Ann Ig. 2025 Jan-Feb;37(1):84-96. doi: 10.7416/ai.2024.2659.

ABSTRACT

AIM: The lack of health professionals and the physicians’ migration trend represents a challenging issue for the health systems’ sustainability worldwide. The current study aims to evaluate the intentions of Italian medical students to pursue their own careers abroad by investigating the push and pull factors of migration.

SUBJECT AND METHODS: A cross-sectional study was performed among Italian medical students through a self-administered questionnaire. Primary and secondary outcomes were established as the intention of moving abroad after graduation and knowledge about residency programmes, application, quality training and remuneration in the country of interest. Descriptive analysis for all variables and univariable and multivariable regression for primary and secondary outcomes were performed.

RESULTS: Overall, 307 medical students took part in the study. More than half of the sample considered moving abroad after graduation, mainly to find a higher quality training programme. Regression analysis highlighted a significant association between the primary outcome and general personal and professional reasons, as well as previous experiences abroad, whereas bureaucratic procedures were perceived as the main barrier. Perceived better knowledge about residency programmes and quality of training related to sources of information such as the Internet (blogs, forums, websites) and medical associations.

CONCLUSION: Retention policies are necessary to meet the expectations and requests of future generations of doctors by allocating financial resources to offer high-quality training and broad career opportunities, together with appropriate wages, as crucial factors for discouraging the migration of healthcare professionals.

PMID:39498548 | DOI:10.7416/ai.2024.2659

Pharmacotherapy. 2024 Nov 5. doi: 10.1002/phar.4622. Online ahead of print.

ABSTRACT

Cannabinoids have emerged as a potential treatment for obstructive sleep apnea (OSA). This systematic review aimed to summarize the efficacy and safety of cannabinoids to treat OSA. Databases including Ovid MEDLINE, EMBASE, Scopus, PsycINFO, and International Pharmaceutical Abstracts were searched; experimental and observational studies were eligible for inclusion. One-hundred seventy unique records were screened, and nine studies included: five full-text studies and four published abstracts. The five full-text studies were judged for quality appraisal: two studies deemed at low risk for bias, one study deemed to have some concerns for bias, and two studies deemed to have high risk for bias. Seven of nine total studies were experimental designs and evaluated dronabinol, and the other two studies were observational designs evaluating cannabis. The range of cannabinoid therapy duration spanned from 1 to 6 weeks, and the median duration was 3 weeks. Eight of nine total studies reported statistically significant, positive OSA outcomes due to cannabinoid therapy including reductions in the apnea hypopnea index and improvements in patient-reported daytime sleepiness scales. Between 70% and 80% of study participants reported neuropsychiatric and gastrointestinal adverse events attributable to cannabinoids. The American Academy of Sleep Medicine does not recommend using cannabinoids to treat OSA due to a lack of long-term safety and efficacy data. This systematic review found similar limitations, with the median cannabinoid treatment duration being only 3 weeks. Adequately powered experimental trials over longer time frames are necessary to more completely assess the long-term efficacy and safety of cannabinoids in the treatment of OSA and its effects on common comorbid conditions, such as obesity and cardiovascular disease.

PMID:39498540 | DOI:10.1002/phar.4622

Eur J Psychotraumatol. 2024;15(1):2420464. doi: 10.1080/20008066.2024.2420464. Epub 2024 Nov 5.

ABSTRACT

Background: Research on the prevalence of ICD-11-based complex posttraumatic stress disorder (CPTSD) in nationally representative samples is lacking, with no such studies conducted considering national Polish samples until now.Objectives: The primary aim of this study was to explore profiles of study participants in terms of either PTSD or CPTSD symptoms regarding to ICD-11 diagnosis with the aid of latent profile analysis. We also investigated the relationship between the types and cumulative number of adverse childhood experiences (ACEs) with the probability of CPTSD rate in a national sample of Poles.Methods: A representative sample of Polish adults (n = 3,557) participated in this study. ACEs were assessed using the Adverse Childhood Experiences Questionnaire, while the core features of PTSD and CPTSD were measured using the International Trauma Questionnaire.Results: The findings showed a 11% prevalence rate of probable CPTSD in the studied sample of Poles. Sexual abuse, emotional neglect, physical neglect and having the experience of a mentally ill household member were the most significant predictors of potential diagnosis. Furthermore, significant differences concerning lifestyle data were observed in the group of participants with CPTSD.Conclusions: The current rate of probable CPTSD in Poland is substantially higher than the respective data reported for other countries. We also noted that the ICD-11 diagnosis of CPTSD may not apply to all cultural environments. Finally, it was observed that the ACEs – CPTSD association may depend both on the ACEs types as well as on their overall cumulative character.

PMID:39498533 | DOI:10.1080/20008066.2024.2420464

Phys Chem Chem Phys. 2024 Nov 5. doi: 10.1039/d4cp03447c. Online ahead of print.

ABSTRACT

Dynamical control of reactivity for the deazetization of endo,endo-9,10-diazatetracyclo[3.3.2.0^2,4.0^6,8]dec-9-ene (3) is studied using on-the-fly quasi-classical trajectory (QCT) calculations at the density functional theory (DFT) level. Two degenerate homotropilidenes, 4 and 5, are formed simultaneously from a single transition state (TS). The ratio of the cyclohexadienyl substituted product, 4, and the dynamical product, i.e. bridgehead substituted product, 5, can be neatly controlled by tuning the topology of the potential energy surface (PES). A steep descent post-TS favors the cyclohexadienyl substituted product while a shallow descent increases the dynamical outcome. Chemical demonstration of the same is achieved by symmetrical and asymmetrical substitution of functional groups along the cleaving (C3-C4) bond. Asymmetric mono-functionalization makes the PES broader, thereby reducing the slope post-TS. This creates a favourable situation for the dynamical products, 5b-5d, to become the major ones. On the contrary, symmetric bi-functionalization makes the cyclohexadienyl substituted product, 4m-4o, overwhelmingly (>85%) predominating. As a corollary to this phenomenon, substitution of the C3-C4 bond by the heavier isotopologues of H/C restricts its motion along the IRC path by the Newtonian kinetic isotope effect. This facilitates bond-opening along the C10-C11 dynamical pathway. Hence, for isotopic substitution, the situation is reversed and the bifunctionalized 3 is more dynamically activated. Simultaneous substitution by the heavier isotopologue of C and H causes deviation from the geometric mean of individual isotopic substitution towards the dynamical product, 5. Therefore, the dynamic control in 3 becomes prominent either via functional group asymmetry or through a Newtonian kinetic isotope effect for symmetric bifunctionalization.

PMID:39498517 | DOI:10.1039/d4cp03447c