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BMJ Paediatrics Open Jun 2024Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This...
BACKGROUND
Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This multicountry survey aimed to elucidate current practices, challenges and case definitions in managing NS among clinicians in Sub-Saharan Africa.
METHODS
The survey targeted physicians and medical practitioners working in neonatal care who participated in a Self-Administered Web Questionnaire. The main objective was to understand NS and infection case definitions and management from the clinician's point of view and to identify challenges and opportunities in sepsis management. Participants were queried on demographics, definitions and diagnostic criteria, treatment approaches, and infection prevention and control (IPC) measures. A total of 136 participants from 93 healthcare structures responded, providing valuable insights into NS management practices.
RESULTS
From May to July 2022 across 21 Sub-Saharan African countries, 136 neonatal clinicians with an average from 93 structures with on average 10-year experience took the survey. NS ranked highest among prevalent neonatal conditions. Diagnostic case definitions between sepsis and infection were attributed to clinical signs, anamnesis, C reactive protein, white blood cll count and blood cultures with no statistically significant differences. Early-onset sepsis was defined within 72 hours by 48%, while late-onset varied. Antibiotics were likely on admission (86.4%) and during the stay (82.2%). Treatment abandonment was reported unlikely. The preferred antibiotic regimen for early-onset sepsis was intravenous amoxicillin (or ampicillin), gentamycin and cefotaxime. Blood culture availability and IPC protocols were reported as limited, particularly concerning patient environment, pharmacy protocols and clean-dirty circuits.
CONCLUSIONS
This NS survey emphasises clinicians' challenges due to limited access to diagnostic tools and raises concerns about antimicrobial overexposure. IPC also seem limited, according to participants. Addressing these challenges can enhance diagnostic practices, antibiotic stewardship and infection control in the region.
Topics: Humans; Neonatal Sepsis; Infant, Newborn; Africa South of the Sahara; Surveys and Questionnaires; Practice Patterns, Physicians'; Male; Female; Anti-Bacterial Agents
PubMed: 38886111
DOI: 10.1136/bmjpo-2023-002398 -
BMJ Paediatrics Open Jun 2024Depression is common among adolescents living with HIV (ALHIV) and impacts their quality of life. However, it is not routinely detected and treated due to a lack of...
Use of computer-assisted self-interview in detection of and referral for depression among adolescents living with HIV at an urban HIV treatment clinic in Uganda: a quasi-experimental study.
BACKGROUND
Depression is common among adolescents living with HIV (ALHIV) and impacts their quality of life. However, it is not routinely detected and treated due to a lack of screening tools, coupled with large numbers of clients in the HIV clinics and limited staff. Enabling adolescents to do a self-assessment for depression on a tablet computer could possibly improve the detection of depression in this population. We set out to assess the detection and referral of depression among ALHIV in care in Uganda.
METHODS
This was a quasi-experimental study design with a historical control at Baylor College of Medicine of Children's Foundation. We conducted a retrospective chart review of 425 adolescents covering a 3-month period and documented the proportion screened for depression and referred to the clinic counsellors. From July to September 2022, eligible adolescents aged 10-19 years who had assented and consented self-assessed for depression using a Patient Health Questionnaire-Adolescent on a tablet computer-assisted self-interview (CASI). Adolescents who screened positive had a prompt on the tablet computers referring them to the counsellor for mental healthcare. We compared the proportions of participants screened for depression and referred to counsellors from clinic chart review and on the CASI using paired t-tests.
RESULTS
Out of 425 medical records reviewed, 54% (231/425) were females and the median age was 15 years. Of the participants who self-assessed on the CASI, 52% (222/425) were males and the median age of all participants was 16 years. Self-assessment on the CASI increased the rate of detection of depression from 0% to 23.3%. Of those referred on the CASI, 15% accessed care at the referral point.
CONCLUSION
The use of CASI improves the rate of detection of depression among ALHIV; however, there is a need to address the barriers to effective referral for mental health services.
Topics: Humans; Adolescent; Uganda; Female; Male; HIV Infections; Referral and Consultation; Retrospective Studies; Depression; Child; Young Adult; Quality of Life; Diagnosis, Computer-Assisted
PubMed: 38886110
DOI: 10.1136/bmjpo-2023-002383 -
RMD Open Jun 2024To compare longitudinal changes in spirometric measures between patients with rheumatoid arthritis (RA) and non-RA comparators.
OBJECTIVE
To compare longitudinal changes in spirometric measures between patients with rheumatoid arthritis (RA) and non-RA comparators.
METHODS
We analysed longitudinal data from two prospective cohorts: the UK Biobank and COPDGene. Spirometry was conducted at baseline and a second visit after 5-7 years. RA was identified based on self-report and disease-modifying antirheumatic drug use; non-RA comparators reported neither. The primary outcomes were annual changes in the per cent-predicted forced expiratory volume in 1 s (FEV%) and per cent predicted forced vital capacity (FVC%). Statistical comparisons were performed using multivariable linear regression. The analysis was stratified based on baseline smoking status and the presence of obstructive pattern (FEV/FVC <0.7).
RESULTS
Among participants who underwent baseline and follow-up spirometry, we identified 233 patients with RA and 37 735 non-RA comparators. Among never-smoking participants without an obstructive pattern, RA was significantly associated with more FEV% decline (β=-0.49, p=0.04). However, in ever smokers with ≥10 pack-years, those with RA exhibited significantly less FEV% decline than non-RA comparators (β=0.50, p=0.02). This difference was more pronounced among those with an obstructive pattern at baseline (β=1.12, p=0.01). Results were similar for FEV/FVC decline. No difference was observed in the annual FVC% change in RA versus non-RA.
CONCLUSIONS
Smokers with RA, especially those with baseline obstructive spirometric patterns, experienced lower FEV% and FEV/FVC decline than non-RA comparators. Conversely, never smokers with RA had more FEV% decline than non-RA comparators. Future studies should investigate potential treatments and the pathogenesis of obstructive lung diseases in smokers with RA.
Topics: Humans; Arthritis, Rheumatoid; Male; Spirometry; Female; Middle Aged; Longitudinal Studies; Prospective Studies; Smoking; Aged; Forced Expiratory Volume; Vital Capacity; Pulmonary Disease, Chronic Obstructive; Adult; United Kingdom
PubMed: 38886003
DOI: 10.1136/rmdopen-2024-004281 -
Interdisciplinary Cardiovascular and... Jun 2024Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing...
OBJECTIVES
Enhanced Recovery After Surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital.
METHODS
The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists, and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training, and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the first patients, followed by analysis and full implementation.
RESULTS
Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings, and continuous feedback loops. Preliminary data from the initial cohort showed improvement in early mobilization, opioid use, respiratory complications, and shorter hospital stays.
CONCLUSIONS
The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.
PubMed: 38885412
DOI: 10.1093/icvts/ivae118 -
PloS One 2024Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with...
Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with frequent medical and surgical care and high treatment costs. There is paucity of information on the pattern of non-traumatic orthopedic conditions in low and middle income countries. The purpose of this study was to determine the epidemiology of non-traumatic orthopedic conditions among inpatients at the Kenyatta National Hospital in Kenya. This was a cross-sectional study with a sample of 175 charts reviewed. Approximately, 70.3% of the inpatients were aged between 25 to 64 years of age with the mean age of 39.97 years (STD 18.78). Ever married tended to be older 53.5 (95% CI: 46.8-60.2) years than other marital statuses. Approximately, 60.6% were males, 38.9% had comorbidities and 49.1% were casuals or unemployed. All inpatients were Kenyans with Nairobi County comprising 52.6% of all inpatients. Approximately, 77.7% were self-referrals. The commonest non-trauma orthopaedic conditions were infection and non-union (35.4%) and spinal degenerative diseases (20.60%) and the least was limb deformities (1.70%). Compared to females, males were 3.703 (p<0.001) times more likely to have infection and non-union. Patients with primary, secondary and tertiary education were 88.2% (p<0.001), 75.6% (p<0.001) and 68.1% (p = 0.016) less likely to have infection and non-union compared to those with no or preschool education. Widows were 8.500 (p = 0.028) times more likely to have spinal degenerative disease than married. Males were 70.8% (p = 0.031) less likely to have osteoarthritis than females. Inpatients with secondary education were 5.250 (p = 0.040) times more likely to have osteoarthritis than those with no or preschool education. In conclusion, majority of inpatients were young and middle aged adults. Infection and non-union and spinal degenerative diseases were the most common non-trauma orthopedic conditions. While males and those with low education were more likely to have infection and non-union, married were more likely to have spinal degenerative disease. Osteoarthritis was more likely among female admissions.
Topics: Humans; Kenya; Male; Female; Adult; Middle Aged; Cross-Sectional Studies; Inpatients; Tertiary Care Centers; Young Adult; Hospitals, Teaching; Adolescent; Aged; Musculoskeletal Diseases; Referral and Consultation
PubMed: 38885257
DOI: 10.1371/journal.pone.0303898 -
PloS One 2024Global fashion brands have embraced size-inclusive advertising featuring plus-size models, yet the responses of Asian consumers to such advertising-where the average...
Global fashion brands have embraced size-inclusive advertising featuring plus-size models, yet the responses of Asian consumers to such advertising-where the average body size of women is smaller than in Western markets-have garnered little attention. This study, utilizing the S-O-R model, aimed to investigate whether the relationships among perceived actual and ideal self-congruence, perceived attractiveness and familiarity of a fashion model, and purchase intention vary based on the body size of the fashion model. We tested the hypothesized relationships using ANCOVA, confirmatory factor analysis, and multi-group structural equation modeling, analyzing 623 online survey responses from South Korean female consumers. Actual self-congruence had a greater influence on perceived familiarity in consumers exposed to a thin-sized model compared to those exposed to a plus-sized model. In contrast, ideal self-congruence had a more significant positive impact on the perceived physical attractiveness of the plus-size model than the thin-size model. Furthermore, the plus-size model's perceived physical attractiveness had a more significant positive effect on purchase intention than that of the thin-size model. This study highlights the importance of crafting advertising images that portray plus-size models as physically attractive to elicit favorable responses from Asian consumers.
Topics: Humans; Female; Republic of Korea; Adult; Advertising; Consumer Behavior; Young Adult; Body Size; Surveys and Questionnaires; Asian People; Middle Aged; Body Image
PubMed: 38885249
DOI: 10.1371/journal.pone.0304989 -
PloS One 2024In 2021, Mozambique initiated community-based oral HIV self-testing (HIVST) to increase testing access and uptake among priority groups, including adult males,... (Observational Study)
Observational Study
BACKGROUND
In 2021, Mozambique initiated community-based oral HIV self-testing (HIVST) to increase testing access and uptake among priority groups, including adult males, adolescents, and young adults. Within an HIVST pilot project, we conducted a performance evaluation assessing participants' ability to successfully conduct HIVST procedures and interpret results.
METHODS
A cross-sectional study was performed between February-March 2021 among employees, students (18-24 years of age), and community members, using convenience sampling, in two rural districts of Zambézia Province, Mozambique. We quantified how well untrained users performed procedures for the oral HIVST (Oraquick®) through direct observation using a structured checklist, from which we calculated an HIVST usability index (scores ranging 0-100%). Additionally, participants interpreted three previously processed anonymous HIVST results. False reactive and false non-reactive interpretation results were presented as proportions. Bivariate analysis was conducted using Chi-square and Fisher exact tests.
RESULTS
A total of 312 persons participated (131[42%] community members, 71[23%] students, 110[35%] employees); 239 (77%) were male; the mean age was 28 years (standard deviation 10). Average usability index scores were 80% among employees, 86% among students, and 77% among community members. Main procedural errors observed included "incorrect tube positioning" (49%), "incorrect specimen collection" (43%), and "improper waiting time for result interpretation" (42%). From the presented anonymous HIVST results, 75% (n = 234) correctly interpreted all three results, while 9 (3%) of study participants failed to correctly interpret any results. Overall, 36 (12%) gave a false non-reactive result interpretation, 21 (7%) a false reactive result interpretation, and 14 (4%) gave both false non-reactive and false reactive result interpretations. Community members generally had lower performance.
CONCLUSIONS
Despite some observed testing procedural errors, most users could successfully perform an HIVST. Educational sessions at strategic places (e.g., schools, workplaces), and support via social media and hotlines, may improve HIVST performance quality, reducing the risk of incorrect interpretation.
Topics: Humans; Male; Mozambique; Female; Adult; Rural Population; HIV Infections; Adolescent; Cross-Sectional Studies; Young Adult; Self-Testing; HIV Testing
PubMed: 38885228
DOI: 10.1371/journal.pone.0305391 -
PloS One 2024The most dominant model of hope is cognitive, in which hope is defined as goal-directed thinking, comprising self-agency and goal route identification. Nonetheless,... (Meta-Analysis)
Meta-Analysis
The most dominant model of hope is cognitive, in which hope is defined as goal-directed thinking, comprising self-agency and goal route identification. Nonetheless, competing theories about the fundamental nature of hope remain and further exploration of the construct is warranted. Little is known about whether the cognitive model aligns with how higher education students themselves think about hope. Understanding how "lay" populations conceptualise and experience psychological phenomena is as important as applying scientific theory. Personal beliefs impact on how people make sense of their life experiences and on their wellbeing. Research is specifically needed to explore the conceptualisation and experience of hope within diverse student populations. A systematic review was conducted to identify published scientific research and grey literature presenting qualitative accounts of hope from higher education students. A qualitative meta-synthesis of the eight eligible reports was conducted using thematic analysis and synthesis approaches to identify conceptualisations of hope and its associations with mental health and well-being. Nine themes were identified, reflecting that hope is: fundamental; self-construal over time; goal-directed; cognitive-emotional-behavioural; connection; resilience; dynamic and reciprocal; the inverse of depression; positive. These findings were identified as reflecting conclusions in which at least a moderate level of confidence may be placed. These findings clearly align with the cognitive model of hope, but emphasise the additional facets of fundamentality, self-construal, and negative origins. The implications for higher education institutions include to promote growth mindsets, to support students to learn skills for identifying and pursuing goals, and to provide hope-enhancing interventions as part of their student support provision.
Topics: Humans; Hope; Students; Goals; Cognition; Mental Health; Universities
PubMed: 38885226
DOI: 10.1371/journal.pone.0304596 -
PloS One 2024The human forearm model is commonly employed in physiological investigations exploring local vascular function and oxygen delivery; however, the effect of arm dominance...
The human forearm model is commonly employed in physiological investigations exploring local vascular function and oxygen delivery; however, the effect of arm dominance on exercising forearm hemodynamics and skeletal muscle oxygen saturation (SmO2) in untrained individuals is poorly understood. Therefore, the purpose of this study was to explore the effect of self-identified arm dominance on forearm hemodynamics and SmO2 in untrained individuals during submaximal, non-ischemic forearm exercise. Twenty healthy individuals (23±4 years, 50% female; 80% right-handed) completed three-minute bouts of supine rhythmic (1 second contraction: 2 second relaxation duty cycle) forearm handgrip exercise at both absolute (10kg; 98N) and relative (30% of maximal voluntary contraction) intensities in each forearm. Beat-by-beat measures of forearm blood flow (FBF; ml/min), mean arterial blood pressure (MAP; mmHg) and flexor digitorum superficialis SmO2 (%) were obtained throughout and averaged during the final 30 seconds of rest, exercise, and recovery while forearm vascular conductance was calculated (FVC; ml/min/100mmHg). Data are Δ from rest (mean±SD). Absolute force production did not differ between non-dominant and dominant arms (97±11 vs. 98±13 N, p = 0.606) whereas relative force production in females did (69±24 vs. 82±25 N, p = 0.001). At both exercise intensities, FBFRELAX, FVCRELAX, MAPRELAX, and the time constant tau for FBF and SmO2 were unaffected by arm dominance (all p>0.05). While arm dominance did not influence SmO2 during absolute intensity exercise (p = 0.506), the non-dominant arm in females experienced an attenuated reduction in SmO2 during relative intensity exercise (-14±10 vs. -19±8%, p = 0.026)-though exercise intensity was also reduced (p = 0.001). The present investigation has demonstrated that arm dominance in untrained individuals does not impact forearm hemodynamics or SmO2 during handgrip exercise.
Topics: Humans; Female; Muscle, Skeletal; Forearm; Hemodynamics; Male; Exercise; Adult; Young Adult; Hand Strength; Arm; Regional Blood Flow; Oxygen; Oxygen Consumption
PubMed: 38885214
DOI: 10.1371/journal.pone.0305539 -
Environmental Health Perspectives Jun 2024Depression is a social and public health problem of great concern globally. Identifying and managing the factors influencing depression are crucial for preventing and...
Association of Residential Greenness Exposure with Depression Incidence in Adults 50 Years of Age and Older: Findings from the Cohort Study on Global AGEing and Adult Health (SAGE) in China.
BACKGROUND
Depression is a social and public health problem of great concern globally. Identifying and managing the factors influencing depression are crucial for preventing and decreasing the burden of depression.
OBJECTIVES
Our objectives are to explore the association between residential greenness and the incidence of depression in an older Chinese population and to calculate the disease burden of depression prevented by greenness exposure.
METHODS
This study was the Chinese part of the World Health Organization Study on Global AGEing and Adult Health (WHO SAGE). We collected the data of 8,481 residents years of age in China for the period 2007-2018. Average follow-up duration was 7.00 () years. Each participant was matched to the yearly maximum normalized difference vegetation index (NDVI) at their residential address. Incidence of depression was assessed using the Composite International Diagnostic Interview (CIDI), self-reports of depression, and/or taking depression medication. Association between greenness and depression was examined using the time-dependent Cox regression model with stratified analysis by sex, age, urbanicity, annual family income, region, smoking, drinking, and household cooking fuels. Furthermore, the prevented fraction (PF) and attributable number (AN) of depression prevented by exposure to greenness were estimated.
RESULTS
Residential greenness was negatively associated with depression. Each interquartile range (IQR) increase in NDVI buffer was associated with a 40% decrease [; 95% confidence interval (CI): 0.37, 0.97] in the risk of depression incidence among the total participants. Subgroup analyses showed negative associations in urban residents (; 95% CI: 0.12, 0.86) vs. rural residents, in high-income residents (; 95% CI: 0.11, 0.71) vs. low-income residents, and in southern China (; 95% CI: 0.26, 0.95) vs. northern China. Over 8.0% (; 95% CI: 1.38%, 15.40%) and 1,955,199 (95% CI: 310,492; 3,464,909) new cases of depression may be avoided by increasing greenness exposures annually across China.
DISCUSSION
The findings suggest protective effects of residential greenness exposure on depression incidence in the older population, particularly among urban residents, high-income residents, and participants living in southern China. The construction of residential greenness should be included in community planning. https://doi.org/10.1289/EHP13947.
Topics: Humans; China; Incidence; Aged; Depression; Male; Middle Aged; Female; Cohort Studies; Environmental Exposure; Aged, 80 and over; Residence Characteristics
PubMed: 38885140
DOI: 10.1289/EHP13947