Actus Santé

Debriefing surgery: a systematic review

Objectives Debriefing has been pivotal in medical simulation training but its application to the real-world operating room environment has been challenging. We aimed to review the literature on routine surgical debriefing with specific reference to its implementation, barriers, and effectiveness. Methods Inclusion criteria were studies pertaining to debriefing in routine practice in the operating room. Excluded were studies on simulation and training. We searched the databases Google Scholar, CINAHL, Web of Science Core Collection, PsychINFO, Medline, Embase, and ProQuest Theses & Dissertations Global. The last search was performed in March 2022. Quality was assessed on a 21-point checklist adapted from a standard reporting guideline. Synthesis was descriptive. Results The search identified 19 papers. Publication date ranged from 2007 - 2022. Five studies involved a specific intervention. Methodology of studies included surveys, interviews, and analysis of administrative data. Quality scores ranged from 12 - 19 out of 21. On synthesis we identified four topics: explanations of how debriefing had been implemented; the learning dimensions of debriefing, both team learning and quality improvement at the organisational level; the effect of debriefing on patient safety or the organisation's culture; and the barriers to debriefing. Conclusion Debriefing is valuable for team learning, efficiency, patient safety, and psychological safety. Successful implementation programs were characterised by strong commitment from management and support by frontline workers. Integration with administrative quality and safety processes, and information feedback to frontline workers, are fundamental to successful debriefing programs.
Catégories: Actus Santé

Leveraging Serosurveillance and Postmortem Surveillance to Quantify the Impact of COVID-19 in Africa

Background The COVID-19 pandemic has had a devastating impact on global health, the magnitude of which appears to differ intercontinentally: for example, reports suggest 271,900 per million people have been infected in Europe versus 8,800 per million people in Africa. While Africa is the second largest continent by population, its reported COVID-19 cases comprise <3% of global cases. Although social, environmental, and environmental explanations have been proposed to clarify this discrepancy, systematic infection underascertainment may be equally responsible. Methods We seek to quantify magnitude of underascertainment in COVID-19's cumulative incidence in Africa. Using serosurveillance and postmortem surveillance, we constructed multiplicative factors estimating ratios of true infections to reported cases in African nations since March 2020. Results Multiplicative factors derived from serology data - in a subset of 12 nations - suggested a range of COVID-19 reporting rates, from 1 in 630 infections reported in Kenya (May 2020) to 1 in 15 infections reported in South Africa (November 2021). The largest multiplicative factor, 3,795, corresponded to Malawi (June 2020), suggesting <0.05% of infections captured. A similar set of multiplicative factors for all nations derived from postmortem data points toward the same conclusion: reported COVID-19 cases are unrepresentative of true infections, suggesting a key reason for low case burden in many African nations is significant underdetection and underreporting. Conclusions While estimating COVID-19's exact burden is challenging, the multiplicative factors we present provide incidence curves reflecting likely-to-worst-case ranges of infection. Our results stress the need for expansive surveillance to allocate resources in areas experiencing severe discrepancies between reported cases, projected infections, and deaths.
Catégories: Actus Santé

Geometric changes to the central nervous system organs at risk during chemoradiotherapy for locally advanced nasopharyngeal carcinoma

Background: Considerable geometric changes to the organs at risk (OARs) have been reported during treatment with chemotherapy and intensity modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal carcinoma (LA-NPC). This study aimed to quantify geometric changes to the central nervous system-related OARs (CNS-OARs), during chemo-IMRT for LA-NPC. Methods: This prospective study included 20 patients with LA-NPC, treated with chemo-IMRT. Patients underwent a planning computed tomography (CT-plan) scan with intravenous contrast, followed by six weekly scans without contrast (CT-rep). For CNS-OARs, including the spinal cord, brainstem, optic chiasm and nerves, the globes of the eye, lens, and inner ears, their volume loss, the center of mass (COM) displacement, and spatial deformation was compared among weeks, respectively. The correlation between organ volume reduction and patients weight loss was estimated. Results: The volume of the brainstem, spinal cord, and the globe of left- and right-side eye averagely decreased by 2.6 +/- 2.3% (95% CI: 2.1%, 3.1%), 6.5+/-4.8% (5.6%,7.4%), 9.4+/-6.9% (8.1%, 10.6%) and 9.6+/-7.8% (8.2, 11.1%) respectively. The volume reduction of the spinal cord and that of the brainstem were significantly correlated with patients weight loss. For all OARs, the COM displacement was within 3 mm, except for the lower level of the spinal cord. The DSC value of the spinal cord, brainstem, and the globes of the eye was of higher than 0.85 throughout treatment. Conclusions: The volume and shape changes to the CNS-OARs during chemo-IMRT for NPC were quantifiable, which could be useful to refine radiation treatment protocols.
Catégories: Actus Santé

Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics

Background A substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). However, the spatial distribution and clinical implications of such MAL are incompletely understood. Methods Analyses relied upon imaging and clinical data of patients with AIS from the international MRI-GENIE study. Initially, we systematically evaluated the occurrences of MAL within (i) one and, (ii) several vascular supply territories. Associations between the presence of MAL and important characteristics, such as DWI lesion volume, NIHSS-based acute stroke severity, and long-term functional outcome were subsequently determined. The interaction effect between single and multiple lesion status and DWI lesion volume was estimated by means of Bayesian regression modeling for stroke severity and functional outcome. Results We analyzed 2,466 patients [age: 63.4 (14.8), 39% women], 49.7% of which presented with single lesions. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in several territories. Within most territories (anterior, middle, and posterior cerebral artery, cerebellar), multiple lesions occurred as frequently as single lesions (ratio ~1:1). Only the brainstem region comprised fewer patients with multiple lesions (ratio ~1:4). Patients with MAL presented with a significantly higher DWI lesion volume and acute NIHSS (7.7ml vs. 1.7ml and 4 vs. 3, pFDR<0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1ml versus 5.3ml, pFDR=0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between DWI lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In the case of posterior circulation stroke, DWI lesion volume was linked to a higher acute NIHSS only among those with multiple lesions. Conclusions Multiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher DWI lesion volume and lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only.
Catégories: Actus Santé

Environmental surveillance of poliovirus in four districts within two regions of Ghana

The eradication of poliovirus is at its last phase through the efforts and strategies of Global Polio Eradication Initiation (GPEI). There are very few countries that are still endemic with wild poliovirus (WPV) and others with circulating vaccine derived poliovirus (cVDPV). The aim of the study was to detect silent circulation of WPV and VDPV in four districts within the Eastern and Volta region of Ghana. A systematic longitudinal design was used for the study. The convenient sampling technique was used to collect the samples every four weeks from two open and close sewage systems. The open sewage systems were located in New Juabeng and Ho districts while the close sewage systems were located in Asuogyaman and Ketu South districts. A total of 35 sewage samples were collected from September 2018 to May 2019. L20B and RD cell lines were used for the purification of poliovirus (PV) while real-time reverse transcriptase polymerase chain reaction (rRT-PCR) was use to characterize the serotypes of the PVs. The findings of the study showed that the prevalence of non-polio enterovirus (NPEV) and Sabin were 65.71% and 14.29% respectively. The characterized Sabins were serotype 1 and serotype 3 which were circulating in the two districts within the Eastern Region. The study did not detect any WPV and VDPV but isolated Sabin strains of the poliovirus. This necessitates the need for continuous environmental surveillance for poliovirus nationwide.
Catégories: Actus Santé

Revisiting biological sex as a risk factor for COVID-19: a fact or mirage of numbers?

Biological sex is considered a risk factor for COVID-19. The prevailing view supposes males are about two-fold more impacted than females based on early-stage studies. The observed higher male deaths in COVID-19 are purportedly a result of biological differences that make males more vulnerable to adverse outcomes in infectious diseases. Research and policy paradigms seem to follow a similar line of thought to mitigate COVID-19 impact on populations. The analysis of sex-disaggregated data could help us evaluate the veracity of assertions for a preferred evidence-guided response. The analysis of the sex-disaggregated data available for the top 70 countries contributing about 80% of total deaths (as of 15 September 2021; on average two waves of infections experienced) indicates average Case Sex (Male: Female) ratio (CSR) of 1.09{+/-}0.35 (marginally more male cases) and Death Sex ratio (DSR) of 1.48{+/-} 0.47. Consideration of only laboratory-confirmed cases indicates the mortality sex ratio (MSR) in COVID-19 (MSR-COVID) to be 1.37{+/-}0.30. The prevailing MSR for the same countries was 1.758{+/-}0.409. The relative change in the mortality rate for males as compared to females in COVID-19 (ratio: MSR-COVID/prevailing MSR-PP) was 0.818{+/-}0.261 much lower than anticipated (2 or higher). Overall, over three-fold more countries (51/70) experienced a higher rate of female mortality than male mortality (15/70). Together, it suggests a more disproportionately severe impact of COVID-19 on females than on males, contrary to the prevailing view. Identification and analysis of country-specific factors contributing to differential impact on sexes, whether biological or environmental, seem warranted.
Catégories: Actus Santé

Basic reproduction number projection for novel pandemics and variants. Ancestral SARS-CoV2 R0 projection

The recently derived Hybrid-Incidence Susceptible-Transmissible-Removed (HI-STR) prototype is a deterministic epidemic compartment model and an alternative to the Susceptible-Infected-Removed (SIR) model prototype. The HI-STR predicts that pathogen transmission depends on host population characteristics including population size, population density and some common host behavioural characteristics. The HI-STR prototype is applied to the ancestral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) to show that the original estimates of the Coronavirus Disease 2019 (COVID-19) basic reproduction number ($mathcal{R}_0$) for the United Kingdom (UK) could have been projected on the individual states of the United States of America (USA) prior to being detected in the USA. The Imperial College London (ICL) R0 estimate for the UK is projected onto each USA state. The difference between these projections and ICL estimates for USA states is either not statistically significant on the paired student t-test or epidemiologically insignificant. Projection provides a baseline for evaluating the real-time impact of an intervention. Sensitivity analysis was conducted because of considerable variance in parameter estimates across studies. Although the HI-STR predicts that increasing symptomatic ratio and inherently immune ratio reduce R0, relative to the uncertainty in the estimates of R0 for the ancestral SARS-CoV2, the projection is insensitive to the inherently immune ratio and the symptomatic ratio.
Catégories: Actus Santé

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: a cross-sectional, population-based, multi-level analysis in a German federal state

Background Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. Methods We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression (PHQ2) and anxiety (GAD2) symptoms as well as sociodemographic- and asylum-related covariates, was collected and linked to contextual geo-referenced data on housing environment (Small-area Housing Environment Deterioration index, number of residents, remoteness, urbanity and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Results Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with >=50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. The accommodation-level median odds ratio for GAD2 was 2.10 with contextual-level variance of 16%. For odds of reporting GAD2 / PHQ2, the highest degree of deterioration (OR 2.22; 95% CI 0.52-9.59 / 1.99;0.55-7.18), large accommodation size (1.34;0.59-3.06. / 1.12;0.56-2.26), remoteness (2.16;0.32-14.79 / 3.79;0.62-23.18) and district urbanity (3.05;0.98-9.49 / 1.14;0.46-2.79) showed higher, but statistically not significant, point-estimates. District deprivation demonstrated higher odds for GAD2 (1.21;0.51-2.88) and, inversely, lower odds for PHQ2 (0.88;0.41-1.89). Conclusion We found tendencies for, but no significant, contextual effects of housing environment on ASR mental health in accommodation centres. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.
Catégories: Actus Santé

Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: results from the IMPACC study

Background: Better understanding of the association between characteristics of patients hospital-ized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management. Methods: Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1,164 patients from 20 hospitals across the United States. Disease severi-ty was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multi-variable logistic regression was performed. Findings: The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsuper-vised clustering of ordinal score over time revealed distinct disease course trajectories. Risk fac-tors associated with prolonged hospitalization or death by day 28 included age [≥] 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) hav-ing at least one symptom consistent with PASC, most commonly dyspnea (56% among symp-tomatic patients). Female sex was the only associated risk factor for PASC. Interpretation: Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19. Funding: NIH
Catégories: Actus Santé

Post SARS-CoV-2 cell mediated Immune profiles; Case studies

Cell-mediated immunity (CMI), which includes T-cells (both T helper and cytotoxic), is critical for effective antiviral defenses against coronavirus disease-2019 (COVID-19). To better understand the immunological characteristics of CD markers on T-cells in post-COVID-19 patients, we investigated the expression of differential CD markers in the patient groups in this study. Flow cytometry was used to quantify total lymphocyte count and assess the levels of expression of CD markers in the samples. The percentage of Lymphocytes decreased significantly in the post-SARS-COV-2 patients in comparison to normal subjects, which is usually happening in any viral infection. In contrast to that, expression of CD8 was increased in the patient group having long SARS-COV-2 infection with comorbid complications with respect to the normal individuals and long SARS-COV-2 infection without comorbid complications. This data revealed that the cellular immunological responses corroborated with an earlier report of COVID-19 infection were mediated by CD8 upregulation and cytotoxic T lymphocyte hyperactivation.
Catégories: Actus Santé

Impact of dementia, living in a long-term care facility, and physical activity status on COVID-19 severity in older adults

Background: Japan is fast becoming an extremely aged society and older adults are known to be at risk of severe COVID-19. However, the impact of risk factors specific to this population for severe COVID-19 caused by the Omicron variant of concern (VOC) are not yet clear. Methods: We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive SARS-CoV-2 test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors-dementia, admission from a long-term care facility, and poor physical activity status-and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Results: Of the 4,868 cases analyzed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility, and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility, and poor physical activity status was -0.04 (95% confidence interval -0.07, -0.01), 0.09 (0.06, 0.12), and 0.17 (0.14, 0.19), respectively. Conclusions: Our results suggest that poor physical activity status and living in a long-term care facility have a substantial impact on the risk of severe COVID-19 caused by the Omicron VOC, while dementia might be associated with non-severe illness.
Catégories: Actus Santé

The clinical utility and epidemiological impact of self-testing for SARS-CoV-2 using an-tigen detecting diagnostics: a systematic review and meta-analysis

Introduction Self-testing for COVID-19 (C19ST) based on antigen detecting diagnostics could signifi-cantly support controlling the SARS-CoV-2 pandemic. To inform the World Health Organiza-tion in developing a C19ST guideline, we performed a systematic review and meta-analysis of the available literature. Methods We electronically searched Medline and the Web of Science core collection, performed secondary reference screening, and contacted experts for further relevant publications. Any study published between December 1, 2020 and November 30, 2021 assessing the epidemio-logical impact and clinical utility of C19ST was included. Study quality was evaluated using the Newcastle Ottawa Scale (NOS). The review was registered on PROSPERO (CRD42022299977). Results 11 studies only from high-income countries with an overall low quality (median of 3/9 stars on the NOS) were found. Pooled C19ST positivity was 0.2% (95% CI 0.1% to 0.4%; eight data sets) in populations where otherwise no dedicated testing would have occurred. The impact of self-testing on virus transmission was uncertain. Positive test results mainly resulted in people having to isolate without further confirmation of results (eight data sets). When testing was voluntary by study design, pooled testing uptake was 53.2% (95% CI 36.7% to 68.9%; five data sets. Outside direct health impacts, C19ST reduced quarantine duration and absenteeism from work, and made study participants feel safer. Study participants favored self-testing and were confident that they performed testing and sampling correctly. Conclusions The present data suggests that C19ST could be a valuable tool in reducing the spread of COVID-19, as it can achieve good uptake, may identify additional cases, and was generally perceived as positive by study participants. However, data was very limited and heterogenous, and further research especially in low- and middle-income countries is needed to assess the clinical utility and epidemiological impact of C19ST in more detail.
Catégories: Actus Santé

Validation and Implementation of Real Time PCR for Rapid Identification of Candida auris from Clinical Surveillance Samples in a Local Public Health Laboratory Setting

Background Candida auris is a worldwide emerging pathogen known for causing infections and outbreaks in health care settings. In Orange County, CA, C. auris has been circulating and causing outbreaks in long term care facilities since 2019, with a total of 1,017 cases detected from February 2019 to December 2021. Objective To evaluate an rt- PCR assay for rapid identification and assessment of colonization of C. auris from patient surveillance samples at the OC Public Health Laboratory. Method An extraction protocol using the MasterPure kit and automated EZ1 Advanced XL followed by rt- PCR using PerfeCTa Multiplex qPCR TaqMan, and the 7500 Fast Dx was conducted. The assay was evaluated using 131 previously confirmed patient samples and 123 prospective fresh samples from different body sites. Results The assay was highly reproducible at an LOD of 230 CFU/ml. The sensitivity and specificity of the 131 samples was 90 % and 86 % respectively and for the 123 samples it was 93% and 90% respectively. ROC analysis was calculated using all samples (n = 254) to determine the most ideal diagnostic value. The AUC was 0.922 and optimal cutoff was a cycle threshold 36.78. A CT [≤]37.00 is the ideal diagnostic value for patient surveillance samples. Conclusion The successful implementation of the rt- PCR assay for C. auris in a local public health laboratory allows for accurate and rapid screening and identification of C. auris which can contribute to enhanced surveillance and control of C. auris spread in local health care facilities.
Catégories: Actus Santé

Asymptomatic monkeypox virus infections among male sexual health clinic attendees in Belgium

Background Monkeypox is transmitted by close contact with symptomatic cases, and those infected are assumed to be uniformly symptomatic. Evidence of subclinical monkeypox infection is limited to a few immunological studies which found evidence of immunity against orthopoxviruses in asymptomatic individuals who were exposed to monkeypox cases. We aimed to assess whether asymptomatic infections occurred among individuals who underwent sexually transmitted infection (STI) screening in a large Belgian STI clinic around the start of the 2022 monkeypox epidemic in Belgium. Methods Anorectal and oropharyngeal swabs collected for gonorrhoea/chlamydia screening from May 1 until May 31, 2022 were retrospectively tested by a monkeypox-specific PCR. Cases with a positive PCR result were recalled to the clinic for case investigation, repeat testing and contact tracing. Findings In stored samples from 224 men, we identified three cases with a positive anorectal monkeypox PCR. All three men denied having had any symptoms in the weeks before and after the sample was taken. None of them reported exposure to a diagnosed monkeypox case, nor did any of their contacts develop clinical monkeypox. Follow-up samples were taken 21 to 37 days after the initial sample, by which time the monkeypox-specific PCR was negative, likely as a consequence of spontaneous clearance of the infection. Interpretation The existence of asymptomatic monkeypox infection indicates that the virus might be transmitted to close contacts in the absence of symptoms. Our findings suggest that identification and isolation of symptomatic individuals may not suffice to contain the outbreak.
Catégories: Actus Santé

An ultra-sensitive bacterial pathogens and antimicrobial resistance diagnosis workflow using Oxford Nanopore adaptive sampling sequencing method

Metagenomic sequencing analysis has been implemented as an alternative approach for pathogen diagnosis in recent years, which is independent on cultivation and able to identify all potential antibiotic resistant genes. However, current metagenomic sequencing analysis methods have to deal with low relative amounts of prokaryotic DNA and high amounts of host DNA (> 90%), which significantly decrease the overall microbial detection resolution. The recently released nanopore adaptive sampling (NAS) technology facilitates immediate mapping of individual nucleotides to a given reference as each molecule is sequenced. User-defined thresholds allow for the retention or rejection of specific molecules, informed by the real-time reference mapping results, as they are physically passing through a given sequencing nanopore. We developed a metagenomics workflow for ultra-sensitive diagnosis of bacterial pathogens and antibiotic resistance genes (ARGs) from clinic samples, which is based on the efficient selective 'human host depletion' NAS sequencing, real-time species identification and species-specific resistance genes prediction. Our method increased microbial sequences yield at least 8-fold in all 11 sequenced clinical routine Bronchoalveolar Lavage Fluid (BALF) samples (4.5h from sample to result), displayed 100% sensitivity and specificity for pathogen detection compared with cultivation method, and accurately detected antibiotic resistance genes at species level.
Catégories: Actus Santé

Using machine learning probabilities to identify effects of COVID-19

COVID-19, the disease caused by the SARS-CoV-2 virus, has had and continues to have extensive economic, social and public health impacts in the United States and around the world. To date, there have been more than 500 million reported cases of SARS-CoV-2 infection worldwide with more than 6 million reported deaths, more than 80 million of those cases and more than 1 million of those deaths have been reported in the United States. Retrospective analysis throughout the pandemic, which identified comorbidities, risk factors and treatments, has underpinned the response COVID-19. As the situation transitions from a pandemic to an endemic, retrospective analyses using electronic health records will be increasingly important to identify long term effects of COVID-19. However, these analyses can be complicated by the incompleteness of electronic health records, which in turns makes it difficult to differentiate visits where the patient has COVID-19. To address this, we trained a random forest classifier to assign a probability of a patient having been diagnosed with COVID-19 during each visit using demographic data, temporal data and visit-specific diagnoses (Training AUROC = 0.9867, Training OOB AUROC = 0.8957, Evaluation AUROC = 0.8958). Using these probabilities, we identified conditions associated with higher COVID-19 probabilities irrespective of clinical history and when accounting for previous diagnosis and estimated the hazards ratio for myocardial infarction (Hazards ratio = 121.736 (87.375, 169.611), p = 3.796E-177 and Hazards ratio = 80.262 (4.134, 4.637), p = 4.543E-256, respectively), urinary tract infection (Hazards ratio = 72.021 (58.116 - 89.253), p < 2.225E-308 and Hazards ratio = 61.380 (51.273 - 73.479), p < 2.225E-308, respectively), acute renal failure (Hazards ratio = 1.264E4 (9.278E4 - 1.724E4), p < 2.225E-308 and Hazards ratio = 6.333E3 (4.947E3 - 8.108E3), p < 2.225E-308, respectively) and type 2 diabetes (Hazards ratio = 345.730 (283.180 - 422.098), p < 2.225E-308 and Hazards ratio = 217.271 (187.898 - 251.235), p = 1.39E-22, respectively) when accounting for demographics and the ten most common clinical conditions.
Catégories: Actus Santé

A measurement invariance analysis of selected opioid overdose knowledge scale (OOKS) items among bystanders and first responders

Aims. The Opioid Overdose Knowledge Scale (OOKS) is a widely used instrument for assessing pre- and post-training knowledge about opioid-related overdoses and overdose reversal using naloxone. It is often used as an adjunct to opioid education and naloxone distribution (OEND) but the extent to which the OOKS performs comparably for bystander and first responder groups has not been well determined. We used exploratory structural equation modeling (ESEM) to assess the measurement invariance of an OOKS item subset used as a pre-test at OEND trainings. Methods. This study was a secondary analysis of pre-test data collected from 446 first responders and 1,349 bystanders (N = 1,795) attending OEND trainings conducted by two county public health departments. The pre-test consisted of 24 items selected by practitioner/trainer consensus from the original 45-item OOKS instrument. We removed an additional 2 of the 24 items during preliminary analyses owing to low response variation given near 100% correct responses to both items. We used exploratory factor analysis (EFA) followed by ESEM to first identify a factor structure, which we then assessed for configural, metric, and scalar measurement invariance by participant group using the 22 dichotomous items (correct/incorrect) as factor indicators. Results. EFA identified a 3-factor model consisting of items dealing with basic overdose risk information, signs of an overdose, and rescue procedures/advanced overdose risk information. Comparison of model fit by ESEM estimation versus confirmatory factor analysis showed the ESEM model afforded a better fit. Measurement invariance analyses indicated the 3-factor model fit the data well at the level of scalar measurement invariance per standard fit statistic metrics such as CFI, TLI, SRMS, and RMSEA. Conclusions: The reduced set of 22 OOKS items appears to offer directly comparable measurement of pre-training knowledge on opioid overdose risks, signs of an overdose, and rescue procedures for both bystanders and first responders.
Catégories: Actus Santé

Quantitative G6PD point-of-care test can be used reliably on cord blood to identify male and female newborns at increased risk of neonatal hyperbilirubinaemia: a mixed method study

Introduction: New point-of-care (POC) quantitative G6PD testing devices developed to provide safe radical cure for P. vivax malaria may be used to diagnose G6PD deficiency in newborns at risk of severe neonatal hyperbilirubinaemia, improving clinical care, and preventing related morbidity and mortality. Methods: We conducted a mixed-methods study analyzing technical performance and usability of the "STANDARD G6PD" Biosensor when used by trained midwives on cord blood samples at two rural clinics on the Thailand-Myanmar border. Results: In 307 cord blood samples, the Biosensor had a sensitivity of 1.000 (95%CI 0.859-1.000) and a specificity of 0.993 (95% CI 0.971-0.999) as compared to gold standard spectrophotometry to diagnose G6PD deficient newborns using a receiving operator characteristic (ROC) analysis-derived threshold of 4.8IU/gHb. The Biosensor had a sensitivity of 0.640 (95%CI 0.426-0.813) and specificity of 0.954 (95%CI: 0.819-0.981) for 30-70% activity range in females using ROC analysis-derived thresholds of 4.9 to 9.9IU/gHb. These thresholds allowed identification of all G6PD deficient neonates and 80% of female neonates with intermediate phenotypes. Need of phototherapy treatment for neonatal hyperbilirubinaemia was higher in neonates with deficient and intermediate phenotypes as diagnosed by either reference spectrophotometry or Biosensor. Focus group discussions found high levels of learnability, willingness, satisfaction, and suitability for the Biosensor in this setting. The staff valued the capacity of the Biosensor to identify newborns with G6PD deficiency early ("We can know that early, we can counsel the parents about the chances of their children getting jaundice") and at the POC, including in more rural settings ("Because we can know the right result of the G6PD deficiency in a short time. Especially for the clinic which does not have a lab"). Conclusions: The Biosensor is a suitable tool in this resource-constrained setting to identify newborns with abnormal G6PD phenotypes at increased risk of neonatal hyperbilirubinaemia.
Catégories: Actus Santé

Attitude towards Mental Help-Seeking, Motivation, and Economic Resources in Connection with Positive, Negative, and General Psychopathological Symptoms of Schizophrenia: A Pilot Study of a Psychoeducation Program

Background: Pharmacological treatment is usually the first line of treatment for schizophrenia, but more strategies are needed to augment this treatment to promote better outcomes. In literature, many programs have been found to increase mental help-seeking and reducing symptom severity but most are from the Western cultures and/or are conducted with people attending any institution (i.e., a university or an in-patient care unit) and with specific age ranges (i.e., young adults or older adults). However, in the noninstitutionalized population of different age groups of Pakistan, there is a need to find ways (alongside medication) that promote attitude toward mental help-seeking and reduce symptom severity. Therefore, the current pilot study was designed to investigate the impact of a psychoeducation program on increasing patients motivations and help-seeking attitudes toward treatment, reducing the severity of the symptoms, and the role of financial sources in the course of their illness. Methodology: In this pilot study, we targeted diagnosed patients with schizophrenia disorder from different hospitals and primary care clinics. After eligibility screening, 255 participants were included, and 220 completed the psychoeducation program. Both men, 143(56.08%) and women, 112(43.82%) with marital statuses of being single 123(48.24%), married 98(38.43%) and divorced/widower/widowed 34(13.33%) were included. Respondents age range was 18-52 years (M=35.45, SD=10.27). Results: Findings revealed that significant change in symptoms severity was observed after 16-weeks psycho-education program on positive symptoms (Md=21.05, n=220) compared to before (Md=25.00, n=220, z=-12.47, p=.000, {eta} p 2 = .59, negative symptoms (Md=15.74, n=220) compared to before (Md=17.44, n=220, z=-9.52, p=.000, {eta} p 2 = .45, and general psychopathological symptoms (Md=38.32, n=220) compared to before (Md=43.40, n=220, z=-12.72, p=.000, {eta} p 2 = .61. Similarly, on HSAT (Md=39.03, n=220) compared to before (Md=28.27, n=220, z=-10.43, p=.000, {eta} p 2 = .50, and PMFT (Md=5.69, n=220) compared to before (Md=4.85, n=220, z=-12.43, p=.000, {eta} p 2 = .59 respectively. Change in patients motivation after 16-weeks at low motivation level was -55(25%) (this category got reduced as people moved to better motivation levels), at moderate motivation level it was 10(4.55%) and at high motivation level it was 45(20.45%). Symptoms severity reduced in across all income groups but patients in low-income group tended to gain more from the psychoeducation programas compared to middle- and high-income group in both pre and post treatment. Conclusion: It is concluded that our psychoeducation program helps promote patients motivation and help-seeking attitude toward treatment, and helps reduces positive, negative, and general symptoms severity across all age groups and income groups. However, one of the limitations of this psychoeducation program is that it appears to be more advantageous for patients from low-income group as compared to middle- and high-income groups. However, this limitation can be considered a strength in a country like Pakistan where around 40% of the population lives in poverty. Usually, lower income groups tend to be worse off when it comes to treatment outcomes of any kind, but psychoeducation seems to be the avenue that appears different.
Catégories: Actus Santé

Digital media does not harm (nor benefit) brain development in children

Importance Digital media takes an increasingly large part of children time, but the effect on brain development is unclear. Objective To investigate the effects of digital media (watching television and videos, using social media, or playing video games respectively) on the development of the cortex, striatum, and cerebellum over two years. Design, setting, and participants A prospective, multicenter, longitudinal study of children from the Adolescent Brain and Cognitive Development Study, recruited between 2016 and 2018. Children underwent magnetic resonance imaging scan at two different time points and completed the Youth Screen Time Survey at first timepoint, answering questions about digital media use. The analysis controlled for differences in socioeconomic status (SES) and polygenic scores for educational attainment. Exposure Digital media use. Main outcome measures The primary outcome measure was the changes in the global cortical surface area. Results 6492 children (age in months, mean [SD] = 118.6 [7.2], i.e., 9.9 years were included at the baseline. Of these, 4502 children (age in months = 142.6 [7.6], i.e., 11.9 years were included at the two years follow up. The average time spent by children on screen time was 2.2h/day for watching television and videos, 0.4h/day for using social media, and 0.9h/day for playing video games. Over the two year observation period, the average cortical surface area increased by approximately 2%, reflecting normal cortical development. The amount of time spent playing video games was weakly but positively correlated to change in global cortical surface area (standardised beta, {beta} = 0.03; 95% CI [0.001 0.06]; P=.06). No global or regional effect on brain development was observed for a time watching television and videos or using social media. However, the regional analysis showed that playing video games was associated with a larger increase in the volume of the cerebellum ({beta} = 0.01 [0.001 0.02]; P=.02). Conclusions and Relevance This study does not suggest that digital media use in children harms brain development in mid-childhood and within a window of two years, but a longer follow-up is necessary. Keywords Videogames, gaming, MRI, brain, children, polygenic score
Catégories: Actus Santé

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