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Annals of Family Medicine Jun 2024Relationship continuity of care has declined across English primary health care, with cross-sectional and longitudinal variations between general practices predicted by...
PURPOSE
Relationship continuity of care has declined across English primary health care, with cross-sectional and longitudinal variations between general practices predicted by population and service factors. We aimed to describe cross-sectional and longitudinal variations across the COVID-19 pandemic and determine whether practice factors predicted the variations.
METHODS
We conducted a longitudinal, ecological study of English general practices during 2018-2022 with continuity data, excluding practices with fewer than 750 patients or National Health Service (NHS) payments exceeding £500 per patient. Variables were derived from published data. The continuity measure was the product of weighted responses to 2 General Practice Patient Survey questions. In a multilevel mixed-effects model, the fixed effects were 11 variables' interactions with time: baseline continuity, NHS region, deprivation, location, percentage White ethnicity, list size, general practitioner and nurse numbers, contract type, NHS payments per patient, and percentage of patients seen on the same day as booking. The random effects were practices.
RESULTS
Main analyses were based on 6,010 practices (out of 7,190 active practices). During 2018-2022, mean continuity in these practices declined (from 29.3% to 19.0%) and the coefficient of variation across practices increased (from 48.1% to 63.6%). Both slopes were steepest between 2021 and 2022. Practices having more general practitioners and higher percentages of patients seen the same day had slower declines. Practices having higher baseline continuity, located in certain non-London regions, and having higher percentages of White patients had faster declines. The remaining variables were not predictors.
CONCLUSIONS
Variables potentially associated with greater appointment availability predicted slower declines in continuity, with worsening declines and relative variability immediately after the COVID-19 lockdown, possibly reflecting surges in demand. To achieve better levels of continuity for those seeking it, practices can increase appointment availability within appointment systems that prioritize continuity.
PubMed: 38914438
DOI: 10.1370/afm.3128 -
Annals of Family Medicine Jun 2024We undertook a study to investigate the relationship between duration of medication use and prevalence of impaired awareness of hypoglycemia (IAH) among patients with...
PURPOSE
We undertook a study to investigate the relationship between duration of medication use and prevalence of impaired awareness of hypoglycemia (IAH) among patients with insulin-treated or sulfonylurea-treated type 2 diabetes in Taiwan.
METHODS
A total of 898 patients (41.0% insulin users, 65.1% sulfonylurea users; mean [SD] age = 59.9 [12.3] years, 50.7% female) were enrolled in pharmacies, clinics, and health bureaus of Tainan City, Taiwan. Presence of IAH was determined with Chinese versions of the Gold questionnaire (Gold-TW) and Clarke questionnaire (Clarke-TW). Sociodemographics, disease and treatment histories, diabetes-related medical care, and health status were collected. We used multiple logistic regression models to assess the relationship between duration of medication use and IAH.
RESULTS
Overall IAH prevalence was 41.0% (Gold-TW) and 28.2% (Clarke-TW) among insulin users, and 65.3% (Gold-TW) and 51.3% (Clarke-TW) among sulfonylurea users. Prevalence increased with the duration of sulfonylurea use, whereas it decreased with the duration of insulin use. After controlling for potential confounders, 5 or more years of sulfonylurea use was significantly associated with 3.50-fold (95% CI, 2.39-5.13) and 3.06-fold (95% CI, 2.11-4.44) increases in the odds of IAH based on the Gold-TW and Clarke-TW criteria, respectively. On the other hand, regular blood glucose testing and retinal examinations were associated with reduced odds in both insulin users and sulfonylurea users.
CONCLUSIONS
The prevalence of IAH was high among patients using sulfonylureas long term, but the odds of this complication were attenuated for those who received regular diabetes-related medical care. Our study suggests that long-term sulfonylurea use and irregular follow-up increase risk for IAH. Further prospective studies are needed to confirm the observed associations.
PubMed: 38914437
DOI: 10.1370/afm.3129 -
Public Health Research & Practice Jun 2024More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the...
OBJECTIVE
More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the sun and protecting their skin less than older adults. A new mass media campaign was delivered in New South Wales, Australia, to motivate this hard-to-reach group to protect their skin from harmful UV radiation. This paper shares learnings from this campaign for public health educators working across diverse fields.
PROGRAM
Guided by audience research and testing, the campaign combined fear-based and self-efficacy messaging. UV radiation was portrayed as arrows descending from the sky, transforming it into a visible and ever-present threat. High-reach channels such as cinema, outdoor advertising, online videos, audio apps and social media were used to reach the audience.
METHODS
The campaign was evaluated through an online tracking survey (n = 750, 18-24-year-olds) measuring prompted recognition, message take-out, key diagnostics, and self-reported sun protection intentions and behaviours.
RESULTS
The evaluation found that 57% of survey participants recognised the campaign when prompted. Among those that recognised the campaign, 76% said they had used sun protection when outdoors over the summer campaign period (vs 64% of non-recognisers, p < 0.05), and 45% said they had adopted at least three of the five sun protection behaviours (Slip, Slop, Slap, Seek and Slide) 'always' or 'often' (vs. 36% of non-recognisers, p < 0.05).
LESSONS LEARNT
A mass-media campaign that aimed to elicit emotional (fear) and cognitive (perceived efficacy) responses and which drew upon social and heuristic cues was associated with greater self-reported sun protection among the target audience. Delivering a combination of message strategies simultaneously within a campaign tailored to young adults may be more effective than adopting a more singular focus.
PubMed: 38914417
DOI: 10.17061/phrp3422416 -
Public Health Research & Practice Jun 2024An asymptomatic COVID-19 rapid antigen testing (RAT) screening program was implemented in Victorian schools in January 2022, to support keeping schools open throughout...
BACKGROUND
An asymptomatic COVID-19 rapid antigen testing (RAT) screening program was implemented in Victorian schools in January 2022, to support keeping schools open throughout the pandemic. This study explored compliance with the program among caregivers from priority populations in Victorian mainstream and specialist schools.
METHODS
We conducted semi-structured interviews between 7-31 March 2022 with caregivers of school-aged children participating in the RAT program in Victoria. Participants were asked about awareness, acceptability, compliance, frequency, and barriers to testing. Recordings were transcribed and deductively analysed using a framework approach.
RESULTS
Fifty caregivers participated. They expressed confusion about the 'recommended' program, assuming it was mandatory. Caregivers wanted notification from schools of positive cases to increase motivation for compliance. Culturally and linguistically diverse (CALD) families were compliant; however, in-language resources were limited. Aboriginal or Torres Strait Islander (Koori) families tested less regularly and received information from their community rather than school. Caregivers of children living with disabilities reported behavioural challenges to testing, resulting in distress or non-compliance, and received non-specific information for their children.
CONCLUSIONS
To increase engagement with future surveillance programs, caregivers need clarity about optionality, conducting tests, reporting results, and timely notification of cases. Requirements unique to each priority population include: accurate in-language information for CALD caregivers, community-led communication for Koori caregivers, tailored information, less testing, and flexibility for caregivers of children living with a disability. Keeping schools open and having tailored strategies to ensure equitable access for priority populations are essential for future pandemic management.
PubMed: 38914416
DOI: 10.17061/phrp34232407 -
Asian Nursing Research Jun 2024The coronavirus disease 2019 (COVID-19), one of the most significant recent emerging infectious diseases, has evolved into a global pandemic, resulting in an...
PURPOSE
The coronavirus disease 2019 (COVID-19), one of the most significant recent emerging infectious diseases, has evolved into a global pandemic, resulting in an unprecedented public health crisis with substantial morbidity. The aim of this study was to investigate the care experiences of nursing staff during the COVID-19 pandemic.
METHODS
A qualitative, exploratory interview study. This study was conducted from August 2022 to January 2023. Participants were recruited from a medical center in northern Taiwan. A purposive sampling approach was employed to select the participants, and in-depth interviews were conducted with a total of 30 individuals. The collected data were analyzed using content analysis.
RESULTS
The findings of this study revealed five themes that summarized the care experiences of participants during the COVID-19 pandemic, enhanced nursing competence in pandemic mitigation, adherence to clear safety measures, effective adaptation to the stress of the "unknown," and recognition of the meaning of the pandemic mitigation experience.
CONCLUSION
This study informs pandemic readiness for nurses and policy enhancement. Medical institutions and governments must prioritize policies ensuring staffing, PPE access, and mental health support. Educators and administrators should elevate on-the-job crisis management training. Future planning should cater to Taiwanese nurses' needs during unforeseen crises such as COVID-19.
PubMed: 38914311
DOI: 10.1016/j.anr.2024.06.002 -
The Lancet. Global Health Jun 2024Pulse oximeters are essential for assessing blood oxygen levels in emergency departments, operating theatres, and hospital wards. However, although the role of pulse... (Review)
Review
Pulse oximeters are essential for assessing blood oxygen levels in emergency departments, operating theatres, and hospital wards. However, although the role of pulse oximeters in detecting hypoxaemia and guiding oxygen therapy is widely recognised, their role in primary care settings is less clear. In this Viewpoint, we argue that pulse oximeters have a crucial role in risk-stratification in both hospital and primary care or outpatient settings. Our reanalysis of hospital and primary care data from diverse low-income and middle-income settings shows elevated risk of death for children with moderate hypoxaemia (ie, peripheral oxygen saturations [SpO] 90-93%) and severe hypoxaemia (ie, SpO <90%). We suggest that moderate hypoxaemia in the primary care setting should prompt careful clinical re-assessment, consideration of referral, and close follow-up. We provide practical guidance to better support front-line health-care workers to use pulse oximetry, including rethinking traditional binary SpO thresholds and promoting a more nuanced approach to identification and emergency treatment of the severely ill child.
PubMed: 38914087
DOI: 10.1016/S2214-109X(24)00209-2 -
Global Spine Journal Jun 2024Meta-analysis. (Review)
Review
STUDY DESIGN
Meta-analysis.
OBJECTIVE
To compare the effectiveness of postoperative pain control between erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block in lumbar spine surgery.
METHODS
PubMed, Embase, and MEDLINE electronic databases were searched for articles containing randomized controlled trials (RCTs) published between January 1900 and January 2024. We extracted the postoperative mean pain score, the first 24-h postoperative morphine consumption, and their standard deviation from the included studies. Meta-analysis was performed using the functions available in the metafor package in R software. We pooled continuous variables using an inverse variance method with a random-effects model and summarized them as standardized mean differences.
RESULTS
Five RCTs that directly compared the ESPB and TLIP block in lumbar spine surgery were included, enrolling 432 participants randomly into the two groups with 216 participants in each group. The pooled analyses showed that there was no significant difference between the ESPB and TLIP groups in terms of lower pain scores during the early (1 h) (standardized mean difference [SMD] -1.49, 95% confidence interval [CI], -3.10; 0.11), middle (12 h) (SMD -3.12, 95% CI, -6.86; 0.61), and late (24 h) (SMD -1.38, 95% CI, -3.01; 0.24) postoperative periods. There was also no significant difference in the first 24-h postoperative morphine equivalent consumption between the ESPB and TLIP groups (SMD -0.46 mg, 95% CI -1.23; 0.31).
CONCLUSION
No significant difference was observed between the ESPB and TLIP block in terms of postoperative pain control and 24-h morphine equivalent consumption for lumbar spine surgery.
PubMed: 38914010
DOI: 10.1177/21925682241266518 -
JMIR Public Health and Surveillance Jun 2024The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of... (Observational Study)
Observational Study
BACKGROUND
The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures.
OBJECTIVE
We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry.
METHODS
We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome.
RESULTS
From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05).
CONCLUSIONS
During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999.
Topics: Humans; Out-of-Hospital Cardiac Arrest; Republic of Korea; COVID-19; Registries; Female; Male; Aged; Middle Aged; Incidence; Retrospective Studies; Aged, 80 and over; Pandemics; Cardiopulmonary Resuscitation
PubMed: 38913998
DOI: 10.2196/52402 -
JMIR AI Jun 2024Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead...
BACKGROUND
Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead many mothers to discontinue breastfeeding. For instance, nipple damage and mastitis affect 80% and 20% of US mothers, respectively. Lactation consultants (LCs) help mothers with breastfeeding, providing in-person, remote, and hybrid lactation support. LCs guide, encourage, and find ways for mothers to have a better experience breastfeeding. Current telehealth services help mothers seek LCs for breastfeeding support, where images help them identify and address many issues. Due to the disproportional ratio of LCs and mothers in need, these professionals are often overloaded and burned out.
OBJECTIVE
This study aims to investigate the effectiveness of 5 distinct convolutional neural networks in detecting healthy lactating breasts and 6 breastfeeding-related issues by only using red, green, and blue images. Our goal was to assess the applicability of this algorithm as an auxiliary resource for LCs to identify painful breast conditions quickly, better manage their patients through triage, respond promptly to patient needs, and enhance the overall experience and care for breastfeeding mothers.
METHODS
We evaluated the potential for 5 classification models to detect breastfeeding-related conditions using 1078 breast and nipple images gathered from web-based and physical educational resources. We used the convolutional neural networks Resnet50, Visual Geometry Group model with 16 layers (VGG16), InceptionV3, EfficientNetV2, and DenseNet169 to classify the images across 7 classes: healthy, abscess, mastitis, nipple blebs, dermatosis, engorgement, and nipple damage by improper feeding or misuse of breast pumps. We also evaluated the models' ability to distinguish between healthy and unhealthy images. We present an analysis of the classification challenges, identifying image traits that may confound the detection model.
RESULTS
The best model achieves an average area under the receiver operating characteristic curve of 0.93 for all conditions after data augmentation for multiclass classification. For binary classification, we achieved, with the best model, an average area under the curve of 0.96 for all conditions after data augmentation. Several factors contributed to the misclassification of images, including similar visual features in the conditions that precede other conditions (such as the mastitis spectrum disorder), partially covered breasts or nipples, and images depicting multiple conditions in the same breast.
CONCLUSIONS
This vision-based automated detection technique offers an opportunity to enhance postpartum care for mothers and can potentially help alleviate the workload of LCs by expediting decision-making processes.
PubMed: 38913995
DOI: 10.2196/54798 -
Journal of Medical Internet Research Jun 2024Comprehensive management of multimorbidity can significantly benefit from advanced health risk assessment tools that facilitate value-based interventions, allowing for...
BACKGROUND
Comprehensive management of multimorbidity can significantly benefit from advanced health risk assessment tools that facilitate value-based interventions, allowing for the assessment and prediction of disease progression. Our study proposes a novel methodology, the Multimorbidity-Adjusted Disability Score (MADS), which integrates disease trajectory methodologies with advanced techniques for assessing interdependencies among concurrent diseases. This approach is designed to better assess the clinical burden of clusters of interrelated diseases and enhance our ability to anticipate disease progression, thereby potentially informing targeted preventive care interventions.
OBJECTIVE
This study aims to evaluate the effectiveness of the MADS in stratifying patients into clinically relevant risk groups based on their multimorbidity profiles, which accurately reflect their clinical complexity and the probabilities of developing new associated disease conditions.
METHODS
In a retrospective multicentric cohort study, we developed the MADS by analyzing disease trajectories and applying Bayesian statistics to determine disease-disease probabilities combined with well-established disability weights. We used major depressive disorder (MDD) as a primary case study for this evaluation. We stratified patients into different risk levels corresponding to different percentiles of MADS distribution. We statistically assessed the association of MADS risk strata with mortality, health care resource use, and disease progression across 1 million individuals from Spain, the United Kingdom, and Finland.
RESULTS
The results revealed significantly different distributions of the assessed outcomes across the MADS risk tiers, including mortality rates; primary care visits; specialized care outpatient consultations; visits in mental health specialized centers; emergency room visits; hospitalizations; pharmacological and nonpharmacological expenditures; and dispensation of antipsychotics, anxiolytics, sedatives, and antidepressants (P<.001 in all cases). Moreover, the results of the pairwise comparisons between adjacent risk tiers illustrate a substantial and gradual pattern of increased mortality rate, heightened health care use, increased health care expenditures, and a raised pharmacological burden as individuals progress from lower MADS risk tiers to higher-risk tiers. The analysis also revealed an augmented risk of multimorbidity progression within the high-risk groups, aligned with a higher incidence of new onsets of MDD-related diseases.
CONCLUSIONS
The MADS seems to be a promising approach for predicting health risks associated with multimorbidity. It might complement current risk assessment state-of-the-art tools by providing valuable insights for tailored epidemiological impact analyses of clusters of interrelated diseases and by accurately assessing multimorbidity progression risks. This study paves the way for innovative digital developments to support advanced health risk assessment strategies. Further validation is required to generalize its use beyond the initial case study of MDD.
Topics: Humans; Retrospective Studies; Multimorbidity; Female; Male; Middle Aged; Risk Assessment; Adult; Aged; Spain; Depressive Disorder, Major; Bayes Theorem; Disease Progression; United Kingdom; Depression; Finland
PubMed: 38913991
DOI: 10.2196/53162