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BMJ Open Jul 2024Suicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been...
INTRODUCTION
Suicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviours among medical students in general, no review has ever assessed or carried out a sub-analysis to show the burden of suicidal behaviours among Bangladeshi medical students.
METHODS AND ANALYSIS
The research team will search the PubMed (Medline), Scopus, PsycINFO and Google Scholar databases for papers published between January 2000 and May 2024 using truncated and phrase-searched keywords and relevant subject headings. Cross-sectional studies, case series, case reports and cohort studies published in English will be included in the review. Review papers, commentaries, preprints, meeting abstracts, protocols and letters will be excluded. Two reviewers will screen the retrieved papers independently. Disagreements between two reviewers will be resolved by a third reviewer. Exposure will be different factors that initiate suicidal behaviours among medical students. The prevalence of suicidal behaviours (suicidal ideation, suicide plans and suicide attempts) in addition to the factors responsible, and types of suicide method will be extracted. Narrative synthesis and meta-analysis will be conducted and the findings will be summarised. For enhanced visualisation of the included studies, forest plots will be constructed. Heterogeneity among the studies will be assessed and sensitivity analysis will be conducted based on study quality. Included studies will be critically appraised using Joanna Briggs's Institutional critical appraisal tools developed for different study designs.
ETHICS AND DISSEMINATION
The study will synthesise evidence extracted from published studies. As the review does not involve the collection of primary data, ethical approval will not be required. Findings will be disseminated orally (eg, conferences, webinars) and in writing (ie, journal paper).
PROSPERO REGISTRATION NUMBER
CDR 42023493595.
Topics: Humans; Students, Medical; Systematic Reviews as Topic; Bangladesh; Meta-Analysis as Topic; Suicidal Ideation; Suicide, Attempted; Research Design; Risk Factors; Prevalence
PubMed: 38964798
DOI: 10.1136/bmjopen-2023-083720 -
BMJ Open Jul 2024To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation. (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluating associations between patient-to-nurse ratios and mortality, process of care events and vital sign documentation on paediatric wards: a secondary analysis of data from the EPOCH cluster-randomised trial.
OBJECTIVE
To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.
DESIGN
Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.
SETTING
22 hospitals caring for children in Canada, Europe and New Zealand.
PARTICIPANTS
Eligible hospitalised patients were aged>37 weeks and <18 years.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.
RESULTS
A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.
CONCLUSIONS
The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.
TRIAL REGISTRATION NUMBER
EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.
Topics: Humans; Vital Signs; Hospital Mortality; Child; Female; Male; Child, Preschool; Infant; Adolescent; Canada; Documentation; Nursing Staff, Hospital; New Zealand; Bayes Theorem; Hospitals, Pediatric
PubMed: 38964797
DOI: 10.1136/bmjopen-2023-081645 -
Journal of Stroke and Cerebrovascular... Jul 2024Subarachnoid hemorrhage (SAH) from spontaneous rupture of an aneurysm is a debilitating condition with high morbidity and mortality. Patients with SAH remain...
OBJECTIVES
Subarachnoid hemorrhage (SAH) from spontaneous rupture of an aneurysm is a debilitating condition with high morbidity and mortality. Patients with SAH remain understudied, particularly concerning the evaluation of incidence and consequences of subsequent acute kidney injury (AKI). In this study, we aim to explore the risk factors and outcomes of AKI in patients with SAH.
MATERIALS AND METHODS
International Classification of Diseases, 9 Edition and 10 Edition (ICD-10-CM) codes were used to query the National Inpatient Sample (NIS) for patients with a diagnosis of SAH between 2010-2019. Subgroup analysis was stratified by AKI diagnosis during the same hospitalization. AKI and non-AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score-matching were performed using IBM SPSS 28.
NEED TO MENTION NIH-SSS RESULTS
Of 76,553 patients diagnosed with nontraumatic SAH between 2010-2019, 10,634 (13.89%) had a comorbid diagnosis of AKI. Patients with AKI were older (p<0.01) and more often obese (p < 0.01), compared to the non-AKI group. A multivariate regression found the diagnosis of AKI to be independently correlated with poor functional outcome (p<0.001), above average length of stay (p < 0.001), and in-hospital mortality (p < 0.001) when controlling for age, SAH severity, and other comorbidities.
CONCLUSIONS
This study showed significant association between AKI and adverse outcomes in SAH patients, and a correlation between AKI and heightened complication rates, poor functional outcome, extended hospital stays, and elevated mortality rates. Early detection of AKI in SAH patients is vital to enhance their chances of recovery.
PubMed: 38964524
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107843 -
The New Zealand Medical Journal Jul 2024To describe urinary incontinence prevalence for New Zealand women.
AIMS
To describe urinary incontinence prevalence for New Zealand women.
METHODS
The New Zealand Health Survey Adult Sexual and Reproductive Health module 2014/2015 was used to estimate urinary incontinence prevalence. Associations between urinary incontinence and age, body mass index (BMI), parity and ethnicity were estimated by logistic regression adjusted for sampling weights.
RESULTS
There were 2,472/5,685 (43.5%) of women aged between and 16 and 74 who responded to the urinary incontinence question and reported at least some incontinence. The sample survey weight-adjusted prevalence (95% confidence interval) was 41.7% (40.0-43.4). An increased prevalence of incontinence was seen with older age, increased BMI and greater parity. The association between BMI and parity was complex, with the lower prevalence with lower BMI attenuated with increasing parity. After adjustment for these variables there was no association with incontinence prevalence for Māori versus non-Māori or European versus non-European.
CONCLUSIONS
Urinary incontinence is highly prevalent in New Zealand women. There was no association with ethnicity after adjusting for older age, increased BMI and parity. The prevalence identified in the New Zealand Health Survey is higher than that reported in older surveys based on the electoral roll.
Topics: Humans; New Zealand; Female; Adult; Urinary Incontinence; Middle Aged; Prevalence; Cross-Sectional Studies; Aged; Adolescent; Young Adult; Parity; Health Surveys; Body Mass Index; Reproductive Health; Sexual Health; Age Factors
PubMed: 38963932
DOI: 10.26635/6965.6575 -
The New Zealand Medical Journal Jul 2024Anti-NMDAR encephalitis is an increasingly recognised autoimmune disorder, with evolving diagnostic criteria. This study aims to analyse the prevalence and diagnostic...
AIMS
Anti-NMDAR encephalitis is an increasingly recognised autoimmune disorder, with evolving diagnostic criteria. This study aims to analyse the prevalence and diagnostic patterns of anti-NMDAR encephalitis in a New Zealand hospital setting.
METHODS
Data from Waikato Hospital's lab database, encompassing anti-NMDAR antibody requests between August 2013 and July 2023, were examined. Cases were categorised based on age, gender and diagnostic outcomes.
RESULTS
In all requests, 288/318 (91%) were processed and 10/288 (3.5%) anti-NMDAR antibodies were positive. Positive cases were equally frequent by sex, with an average age of 29.4 years. Only 6/10 were diagnosed with anti-NMDAR encephalitis, while others received alternative diagnoses. Māori ethnicity was overrepresented. This study indicates a low prevalence of anti-NMDAR encephalitis in the Waikato region, with adult predominance. Ethnic disparities were observed. The need for refining testing criteria to optimise cost-effectiveness is discussed.
CONCLUSION
Anti-NMDAR encephalitis is relatively rare in Waikato Hospital, New Zealand, with diagnostic challenges related to testing criteria and ethnic diversity. Further research and consideration of testing protocols are warranted.
Topics: Humans; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; New Zealand; Female; Male; Adult; Prevalence; Young Adult; Adolescent; Middle Aged; Child; Native Hawaiian or Other Pacific Islander
PubMed: 38963931
DOI: 10.26635/6965.6501 -
The New Zealand Medical Journal Jul 2024To characterise diabetes-related lower extremity amputations (DRLEA) and prior contact with specialist podiatrists in Northern New Zealand.
AIMS
To characterise diabetes-related lower extremity amputations (DRLEA) and prior contact with specialist podiatrists in Northern New Zealand.
METHODS
Using administrative data, DRLEA ≥35 years were identified for the Northern Region (July 2013 to June 2016). For those domiciled in Metro Auckland (July 2015 to June 2016), additional clinical data described amputation cause, diabetes-related comorbidities and podiatry contact.
RESULTS
There were 862 DRLEA for 488 people, including 25% (n=214) major amputations. Age-standardised amputation rates were three times higher for males than females (41.1 vs 13.6 per 100,000 population [95% confidence interval (CI): 37.3-44.9 vs 11.6-15.6 per 100,000] respectively). Amputation rates varied by ethnicity, being 2.8 and 1.5 times higher respectively for Māori and Pacific people than non-Māori, non-Pacific people. Mortality was high at 1-, 3- and 6-months post-admission (7.9%, 12.4 % and 18.3% respectively). There was high prevalence of peripheral vascular disease (78.8%), neuropathy (75.6%), retinopathy (73.6%) and nephropathy (58%). In the 3 months prior to first DRLEA admission, 65% were not seen by specialist podiatry.
CONCLUSIONS
Our study confirms higher DRLEA admission rates for Māori and males. We identified elevated rates among Pacific populations and observed suboptimal utilisation of specialist podiatry services.
Topics: Humans; New Zealand; Male; Amputation, Surgical; Female; Middle Aged; Aged; Diabetic Foot; Lower Extremity; Adult; Podiatry; Native Hawaiian or Other Pacific Islander; Aged, 80 and over; Prevalence
PubMed: 38963930
DOI: 10.26635/6965.6045 -
Journal of Global Health Jul 2024The coronavirus disease 2019 (COVID-19) pandemic led to disruptions of health service delivery in many countries; some were more resilient in either limiting or rapidly...
Evidence of health system resilience in primary health care for preventing under-five mortality in Rwanda and Bangladesh: Lessons from an implementation study during the Millennium Development Goal period and the early period of COVID-19.
BACKGROUND
The coronavirus disease 2019 (COVID-19) pandemic led to disruptions of health service delivery in many countries; some were more resilient in either limiting or rapidly responding to the disruption than others. We used mixed methods implementation research to understand factors and strategies associated with resiliency in Rwanda and Bangladesh, focussing on how evidence-based interventions targeting amenable under-five mortality that had been used during the Millennium Development Goal (MDG) period (2000-15) were maintained during the early period of COVID-19.
METHODS
We triangulated data from three sources - a desk review of available documents, existing quantitative data on evidence-based intervention coverage, and key informant interviews - to perform a comparative analysis using multiple case studies methodology, comparing contextual factors (barriers or facilitators), implementation strategies (existing from 2000-15, new, or adapted), and implementation outcomes across the two countries. We also analysed which health system resiliency capabilities were present in the two countries.
RESULTS
Both countries experienced many of the same facilitators for resiliency of evidence-based interventions for children under five, as well as new, pandemic-specific barriers during the early COVID-19 period (March to December 2020) that required targeted implementation strategies in response. Common facilitators included leadership and governance and a culture of accountability, while common barriers included movement restrictions, workload, and staff shortages. We saw a continuity of implementation strategies that had been associated with success in care delivery during the MDG period, including data use for monitoring and decision-making, as well as building on community health worker programmes for community-based health care delivery. New or adapted strategies used in responding to new barriers included the expanded use of digital platforms. We found implementation outcomes and strong resilience capabilities, including awareness and adaptiveness, which were related to pre-existing facilitators and implementation strategies (continued and new).
CONCLUSIONS
The strategies and contextual factors Rwanda and Bangladesh leveraged to build 'everyday resilience' before COVID-19, i.e. during the MDG period, likely supported the maintained delivery of the evidence-based interventions targeting under-five mortality during the early stages of the pandemic. Expanding our understanding of pre-existing factors and strategies that contributed to resilience before and during the pandemic is important to support other countries' efforts to incorporate 'everyday resilience' into their health systems.
Topics: Humans; COVID-19; Rwanda; Bangladesh; Primary Health Care; Child, Preschool; Child Mortality; Infant; Delivery of Health Care; Infant, Newborn
PubMed: 38963883
DOI: 10.7189/jogh.14.05023 -
JMIR MHealth and UHealth Jul 2024Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these... (Observational Study)
Observational Study
BACKGROUND
Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time.
OBJECTIVE
The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures.
METHODS
We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes.
RESULTS
Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness.
CONCLUSIONS
Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study's application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change.
Topics: Humans; Kenya; Wearable Electronic Devices; Female; Male; Adult; Rural Population; Hot Temperature; Middle Aged; Heart Rate; Cohort Studies; Outcome Assessment, Health Care
PubMed: 38963698
DOI: 10.2196/54669 -
JMIR Research Protocols Jul 2024Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation...
BACKGROUND
Evidence suggests that having a chronic physical illness (CPI; eg, asthma, diabetes, and epilepsy) is an independent risk factor for suicidality (ie, suicidal ideation or attempts) among youth. Less is known about the mechanisms linking CPI and suicidality. Some evidence suggests that mental illness (eg, depression and anxiety) or neurodevelopmental disorder (eg, attention-deficit/hyperactivity disorder) mediates or moderates the CPI-suicidality association. Missing from the knowledge base is information on the association between having co-occurring CPI and mental illness or neurodevelopmental disorder (MIND) on youth suicidality.
OBJECTIVE
This study uses epidemiological data from the 2019 Canadian Health Survey of Children and Youth (CHSCY) to study the intersection of CPI, MIND, and suicidality in youth. We will estimate prevalence, identify predictors, and investigate psychosocial and service use outcomes for youth with CPI-MIND comorbidity versus other morbidity groups (ie, healthy, CPI only, and MIND only).
METHODS
Conducted by Statistics Canada, the CHSCY collected data from 47,850 children (aged 1-17 years) and their primary caregiving parent. Measures of youth CPI, MIND, family environment, and sociodemographics are available using youth and parent informants. Information on psychiatric services use is available via parent report and linkage to national administrative health data found in the National Ambulatory Care Reporting System and the Discharge Abstract Database, which allow the investigation of hospital-based mental health services (eg, emergency department visits, hospitalizations, and length of stay in hospital). Questions about suicidality were restricted to youths aged 15-17 years (n=6950), which form our analytic sample. Weighted regression-based analyses will account for the complex survey design.
RESULTS
Our study began in November 2023, funded by the American Foundation for Suicide Prevention (SRG-0-008-22). Access to the linked CHSCY microdata file was granted in May 2024. Initial examination of CHSCY data shows that approximately 20% (1390/6950) of youth have CPI, 7% (490/6950) have MIND, 7% (490/6950) seriously considered suicide in the past year, and 3% (210/6950) had attempted suicide anytime during their life.
CONCLUSIONS
Findings will provide estimates of suicidality among youth with CPI-MIND comorbidity, which will inform intervention planning to prevent loss of life in this vulnerable population. Modeling correlates of suicidality will advance understanding of the relative and joint effects of factors at multiple levels-information needed to target prevention efforts and services. Understanding patterns of psychiatric service use is vital to understanding access and barriers to services. This will inform whether use matches need, identifying opportunities to advise policy makers about upstream resources to prevent suicidality. Importantly, findings will provide robust baseline of information on the link between CPI-MIND comorbidity and suicidality in youth, which can be used by future studies to address questions related to the impact of the COVID-19 pandemic and associated countermeasures in this vulnerable population of youth.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/57103.
Topics: Humans; Adolescent; Child; Canada; Suicidal Ideation; Suicide, Attempted; Female; Male; Comorbidity; Child, Preschool; Mental Disorders; Infant; Chronic Disease; Prevalence; Risk Factors; Health Surveys
PubMed: 38963692
DOI: 10.2196/57103 -
Journal of Mathematical Biology Jul 2024The Ebola virus disease (EVD) has been endemic since 1976, and the case fatality rate is extremely high. EVD is spread by infected animals, symptomatic individuals, dead...
The Ebola virus disease (EVD) has been endemic since 1976, and the case fatality rate is extremely high. EVD is spread by infected animals, symptomatic individuals, dead bodies, and contaminated environment. In this paper, we formulate an EVD model with four transmission modes and a time delay describing the incubation period. Through dynamical analysis, we verify the importance of blocking the infection source of infected animals. We get the basic reproduction number without considering the infection source of infected animals. And, it is proven that the model has a globally attractive disease-free equilibrium when the basic reproduction number is less than unity; the disease eventually becomes endemic when the basic reproduction number is greater than unity. Taking the EVD epidemic in Sierra Leone in 2014-2016 as an example, we complete the data fitting by combining the effect of the media to obtain the unknown parameters, the basic reproduction number and its time-varying reproduction number. It is shown by parameter sensitivity analysis that the contact rate and the removal rate of infected group have the greatest influence on the prevalence of the disease. And, the disease-controlling thresholds of these two parameters are obtained. In addition, according to the existing vaccination strategy, only the inoculation ratio in high-risk areas is greater than 0.4, the effective reproduction number can be less than unity. And, the earlier the vaccination time, the greater the inoculation ratio, and the faster the disease can be controlled.
Topics: Hemorrhagic Fever, Ebola; Basic Reproduction Number; Humans; Animals; Mathematical Concepts; Models, Biological; Sierra Leone; Ebolavirus; Epidemics; Computer Simulation; Epidemiological Models; Disease Outbreaks
PubMed: 38963509
DOI: 10.1007/s00285-024-02122-8