Conectar
by Aminu S. Abdullahi, Abubaker Suliman, Moien AB Khan, Howaida Khair, Saad Ghazal-Aswad, Iffat Elbarazi, Fatima Al-Maskari, Tom Loney, Rami H. Al-Rifai, Luai A. Ahmed
BackgroundLow hemoglobin (Hb) level is a leading cause of many adverse pregnancy outcomes. Patterns of changes in Hb levels during pregnancy are not well understood.
AimThis study estimated Hb levels, described its changing patterns across gestational trimesters, and identified factors associated with these changes among pregnant women.
Materials and methodsData from the ongoing maternal and child health cohort study–The Mutaba’ah Study, was used (N = 1,120). KML machine learning algorithm was applied to identify three distinct cluster trajectories of Hb levels between the first and the third trimesters. Descriptive statistics were used to profile the study participants. Multinomial multivariable logistic regression was employed to identify factors associated with change patterns in Hb levels.
ResultsThe three identified clusters–A, B and C–had, respectively, median Hb levels (g/L) of 123, 118, and 104 in the first trimester and 119, 100, and 108 in the third trimester. Cluster ’A’ maintained average normal Hb levels in both trimesters. Cluster ’B’, on average, experienced a decrease in Hb levels below the normal range during the third trimester. Cluster ’C’ showed increased Hb levels in the third trimester but remained, on average, below the normal range in both trimesters. Pregnant women with higher gravida, diabetes mellitus (type 1 or 2), nulliparity or lower level of education were more likely to be in cluster ’B’ than the normal cluster ’A’. Pregnant women who reported using iron supplements before pregnancy or those with low levels of education. were more likely to be in cluster ’C’ than the normal cluster ’A’.
ConclusionThe majority of pregnant women experienced low Hb levels during pregnancy. Changes in Hb levels during pregnancy were associated with parity, gravida, use of iron before pregnancy, and the presence of diabetes mellitus (type 1 or 2).
To identify the roles and activities of nurses, including advanced practice nursing (APN), and to determine nursing practice patterns across health facilities in Saudi Arabia.
A descriptive cross-sectional design was used to collect data from 207 nurses working in the Saudi health sector between November 2021 and March 2022 through an online questionnaire. The Advanced Practice Role Delineation tool was used to measure and delineate nursing practice patterns and activities. Data were analysed using descriptive statistics and analysis of variance. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines.
Findings showed that participants, regardless of their current role, reported high scores across all domains of practice. The highest average score was obtained for the Clinical Care domain. Except for the leadership domain, findings showed that those reported working as advanced practice nurses had higher average scores across all domains than those working as staff nurses or being in managerial/administrative positions. There were significant differences in the average Clinical Care scores between advanced practice nurses and staff nurses.
Advanced practice nursing roles and activities are being practised in Saudi Arabia; however, there is no clear delineation of these roles and activities according to a unified and national-level APN scope of practice.
Advanced practice nursing roles are evolving in Saudi Arabia; however, no study has examined the existing patterns of APN activities in Saudi Arabia. This study highlights the practice patterns of advanced practice nurses and adds to the international evidence base on the need for delineating APN activities under a unified scope of practice. The findings of this study are beneficial to practitioners, researchers, and stakeholders as well as the legislative and regulatory bodies.
No patient or public contribution.
by Ramy E. El-Ansary, Samy Kasem, Mohamed A. M. El-Tabakh, Yassien Badr, Ahmed S. Abdel-Moneim
Foot-and-mouth Disease (FMD) is a highly contagious viral disease affecting all hoof-cloven animals. Serotypes A, O and SAT 2 of the foot-and-mouth disease virus (FMDV) are circulating in Egypt. The present study aimed to identify and molecularly characterize the FMDV strains circulating in Northern Egypt during an epidemic that struck the nation in 2022. RNA was extracted from the epithelial specimens, vesicular fluid from affected cattle. The samples were screened using real-time reverse-transcription polymerase chain reaction (RT-PCR) targeting the RNA-dependent RNA polymerase (RdRp) gene. Positive samples underwent individual serotype-specific amplification using primers designed for VP1 of O, A, and SAT 2 serotypes. Subsequently, direct sequencing was performed on the positive samples. The real-time RT-PCR detected positive samples from epithelial and vesicular fluid samples, but not in the blood of infected animals. Out of the 16 samples, seven tested positive for FMDV serotype A. Of these seven positive samples, six were categorized as serotype A-African topotype-G-IV, and these positive samples were isolated in BHK-21 cells, yielding an overt cytopathic effect caused by the virus. In conclusion, it is necessary to sustain continuous surveillance of the evolution of circulating FMDV strains to facilitate the assessment and aid in the selection of vaccine strains for the effective control of FMDV in Egypt.
Poor sleep quality adversely affects the overall well-being and outcomes of patients with chronic kidney disease (CKD). However, it has not been well studied in Africans with CKD. We determined the prevalence of poor sleep quality and associated factors among patients with CKD.
This was a cross-sectional study that involved patients with CKD .
The study was carried out in the outpatient clinic of nine hospitals in Nigeria.
Sleep quality, depressive and anxiety symptoms and quality of life (QoL) were assessed among 307 patients with CKD using Pittsburgh Sleep Quality Index Questionnaire, Hospital Anxiety Depression Scale Questionnaire and 12-item Short Form Health Survey Quality of Life Questionnaire, respectively. The prevalence of poor sleep quality and associated factors were determined. A p
The mean age of the study participants was 51.40±15.17 years. The male:female ratio was 1.5:1 One hundred and twenty-one (39.4%) of the patients were on maintenance haemodialysis (MHD). The prevalence of poor sleep quality, anxiety symptoms and depressive symptoms among the patients was 50.2%, 37.8% and 17.6%, respectively. The prevalence of poor sleep quality in the CKD stages 3, 4, 5 and 5D was 38.1%, 42.6%, 52.2% and 58.7%, respectively. The prevalence of poor sleep quality was significantly higher in MHD patients compared with predialysis CKD (59.5% vs 43.6%; p=0.008). Factors associated with poor sleep quality were CKD stage (p=0.035), anaemia (p=0.003), pruritus (p=0.045), anxiety symptoms (p≤0.001), depressive symptoms (p≤0.001) and reduced QoL (p≤0.001). On multivariate analysis, factors associated with poor sleep were anxiety (AOR 2.19; 95% CI 1.27 to 3.79; p=0.005), anaemia (AOR 5.49; 95% CI 1.43 to 21.00;p=0.013) and reduced physical component of QoL (AOR 4.11; 95% CI 1.61 to 10.47; p=0.003).
Poor sleep quality is common among patients with CKD especially in the advanced stage. The significant factors associated with poor sleep quality were QoL, anaemia and anxiety symptoms. These factors should be adequately managed to improve the overall outcomes of patients with CKD.
by Muntequa Imtiaz Siraji, Ahnaf Akif Rahman, Mirza Muntasir Nishat, Md Abdullah Al Mamun, Fahim Faisal, Lamim Ibtisam Khalid, Ashik Ahmed
Depression is a psychological state of mind that often influences a person in an unfavorable manner. While it can occur in people of all ages, students are especially vulnerable to it throughout their academic careers. Beginning in 2020, the COVID-19 epidemic caused major problems in people’s lives by driving them into quarantine and forcing them to be connected continually with mobile devices, such that mobile connectivity became the new norm during the pandemic and beyond. This situation is further accelerated for students as universities move towards a blended learning mode. In these circumstances, monitoring student mental health in terms of mobile and Internet connectivity is crucial for their wellbeing. This study focuses on students attending an International University of Bangladesh to investigate their mental health due to their continual use of mobile devices (e.g., smartphones, tablets, laptops etc.). A cross-sectional survey method was employed to collect data from 444 participants. Following the exploratory data analysis, eight machine learning (ML) algorithms were used to develop an automated normal-to-extreme severe depression identification and classification system. When the automated detection was incorporated with feature selection such as Chi-square test and Recursive Feature Elimination (RFE), about 3 to 5% increase in accuracy was observed by the method. Similarly, a 5 to 15% increase in accuracy has been observed when a feature extraction method such as Principal Component Analysis (PCA) was performed. Also, the SparsePCA feature extraction technique in combination with the CatBoost classifier showed the best results in terms of accuracy, F1-score, and ROC-AUC. The data analysis revealed no sign of depression in about 44% of the total participants. About 25% of students showed mild-to-moderate and 31% of students showed severe-to-extreme signs of depression. The results suggest that ML models, incorporating a proper feature engineering method can serve adequately in multi-stage depression detection among the students. This model might be utilized in other disciplines for detecting early signs of depression among people.
Psychosocial interventions have been shown to improve mood, relieve stress and improve quality of life for people living with dementia (PwD). To date, most evaluations of singing interventions have focused on the benefits for PwD and not their carers. This research aims to evaluate the benefits of dementia singing groups for both PwD and their carers.
This 2-year project will observe the impact of two different singing intervention services, one combining singing alongside dance and another that includes a sociable lunch. This project will aim to recruit a total of n=150 PwD and n=150 carers across the two singing interventions. Using a mixed-methods approach, the influence of both services will be analysed via the following outcome measures: quality of life, neuropsychiatric symptoms, social isolation, loneliness, cognition, carer burden and depressive symptoms in PwD and their carers using a prestudy/poststudy design. Regression models will be used to analyse the data with time (pre/post) as the exposure variable. Semistructured interviews will be conducted with a subset of people (n=40) to further investigate the impact of singing services with a specific focus on the acceptability of the interventions, barriers to access and prolonged engagement and potential for remote delivery. Interview data will be analysed using Braun and Clarke’s reflexive thematic analysis, and public advisers will assist with coding the transcripts. A social return on investment analysis will be conducted to determine the social impact of the services.
This project has received ethical approval from the University of Liverpool’s Ethics Committee (App ref: 12374) and Lancaster University’s Ethics Committee (App ref: 3442). All participants will provide informed consent to participate. Results will be presented at national and international conferences, published in scientific journals and publicly disseminated to key stakeholders.
by Malindawati Mohd Fadzil, Sharifa Ezat Wan Puteh, Azimatun Noor Aizuddin, Zafar Ahmed, Nor Asiah Muhamad, Abdul Aziz Harith
Dual practice within public hospitals, characterised by the concurrent provision of public and private healthcare services within public hospitals, has become a widespread phenomenon. With the participation of selected public hospitals, dual practice within public hospitals, also known as Full Paying Patient services, was an initiative the Ministry of Health Malaysia took in 2007 to retain senior specialist physicians in Malaysia. The revenue generated from the Full Paying Patient services aims to provide an avenue for public sector specialists to supplement their incomes while alleviating the Government’s burden of subsidising healthcare for financially capable individuals. However, the effectiveness of Full Paying Patient services in recouping service delivery costs and yielding a profit is still uncertain after 16 years of implementation. This study is designed to evaluate the impact of Full Paying Patient inpatient services volume, revenue, and cost on profit versus loss at selected hospitals from 2017 to 2020. From the perspective of healthcare providers, we plan to perform a cost volume profit analysis. This analysis enables us to determine the break-even point, at which total revenues match total costs, along with no-loss and no-profit thresholds for Full Paying Patient services. This study has the potential to provide insights into how variations in service volume, cost, and pricing impact healthcare providers’ profitability. It also offers critical financial information regarding the volume of services required to reach the break-even point. A comprehensive understanding of service volume, cost and pricing is imperative for making informed decisions to fulfil the objectives and ensure the sustainability of the FPP services.
by Saoussen Miladi, Yasmine Makhlouf, Hiba Boussaa, Leith Zakraoui, Kawther Ben Abdelghani, Alia Fazaa, Ahmed Laatar
IntroductionObesity is a growing and debilitating epidemic worldwide that is associated with an increased inflammation. It is often linked to rheumatic diseases and may impact negatively their natural history. The use of bariatric and metabolic surgery (BMS) has increased thanks to its positive effect on major comorbidities like diabetes type 2. This systematic review provides the most up-to-date published literature regarding the effect of BMS on outcomes in rheumatoid arthritis.
MethodsThis systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from Pubmed, Embase and Cochrane, published until June 16th 2023, and tackling the effect of BMS on disease outcomes in patients with RA were included.
ResultsThree studies met the inclusion criteria. They were published between 2015 and 2022. The total number of RA patients was 33193 and 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p Conclusion
To conclude, published data indicate that BMS seems a promising alternative in reducing RA disease activity as well as morbidity and mortality in patients with obesity.
Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service delivery mechanism. This study aimed to examine the current situation of in-hospital trauma care after RTCs to inform the design of a comprehensive service for Bangladesh.
This qualitative study attempted to elicit stakeholders’ perceptions and experiences of managing RTCs through in-depth interviews and focus group discussions. Three districts and Dhaka city were selected based on the frequency of occurrence of RTCs. Fifteen in-depth interviews and 5 focus group discussions were conducted with 38 RTC patients, their relatives and community members in the catchment areas of 11 facilities managing trauma patients. Key informant interviews were conducted with 21 service providers and 17 key stakeholders/policy-makers.
Hospital-based trauma care was generally poor in primary and secondary-level facilities. There was no triage area or triage protocol in the emergency rooms, no trained staff for trauma care, no dedicated RTC patient register and scarce life-saving equipment. Only in Dhaka-based tertiary hospitals was trauma care prioritised. These hospitals follow Advanced Trauma Life Support guidelines and maintain an RTC logbook. Emergency diagnostic services were not always available in the hospitals. Most RTC patients were males; the female participants were additionally vulnerable to physical and mental trauma. Affected people avoided taking legal action considering it a lengthy, complicated and ultimately ineffective process.
The trauma care services currently available in the studied health facilities are very rudimentary and without the necessary human and financial resources. This needs urgent attention from policymakers, programmers and practitioners to reduce morbidity and mortality from the current epidemic of RTCs in Bangladesh.
To understand how student nurse experiences on clinical placement, within National Health Service (NHS) hospitals, differ for ethnic minority and White British groups.
A qualitative thematic analysis with an inductive approach.
Data from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study and asked about their experiences during clinical placement.
Five main themes were identified: (1) Role of mentors, (2) Discrimination and unfair treatment, (3) Speaking up/out, (4) Career progression, and (5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as “ward culture”) providing a context that normalizes mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural and/or religious microaggressions. While being valued for their race and ethnicity, White British students also experienced discrimination and inequity due to their age, sex, gender, and sexual orientation. Students from both White British and ethnic minority groups acknowledged that being treated badly was a barrier to career progression. Ethnic minority students also noted the lack of diverse representation within senior nursing positions discouraged career progression within the UK NHS.
These initial experiences of inequality and discrimination are liable to shape a student's perspective of their profession and ability to progress within nursing. The NHS is responsible for ensuring that student nurses' developmental opportunities are equal, irrespective of ethnicity.
Ward culture is perpetuated by others who normalize mistreatment and concurrently disadvantage ethnic minority students, making them feel unvalued. This in turn impacts both staff retention and career progression within the NHS. Training assessors should be aware of the existing culture of discrimination within clinical placements and work to eradicate it.
by Furat AlAhmed, Anne Rau, Christian Wallraven
The question of how our sensory perception abilities develop has been an active area of research, establishing trajectories of development from infancy that last well into late childhood and even adolescence. In this context, several studies have established changes in sensory processing of vision and touch around the age of 8 to 9 years. In this experiment, we explored the visual and haptic perceptual development of elementary school children of ages 6–11 in similarity-rating tasks of unfamiliar objects and compared their performance to adults. The participants were presented with parametrically-defined objects to be explored haptically and visually in separate groups for both children and adults. Our results showed that the raw similarity ratings of the children had more variability compared to adults. A detailed multidimensional scaling analysis revealed that the reconstructed perceptual space of the adult haptic group was significantly closer to the parameter space compared to the children group, whereas both groups’ visual perceptual space was similarly well reconstructed. Beyond this, however, we found no clear evidence for an age effect in either modality within the children group. These results suggest that haptic processing of unfamiliar, abstract shapes may continue to develop beyond the age of 11 years later into adolescence.
The meta-analysis aimed to assess the effect of hyperbaric oxygen treatment on diabetic foot ulcers. Using dichotomous or contentious random or fixed effect models, the outcomes of this meta-analysis were examined and the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. 17 examinations from 1992 to 2022 were enrolled for the present meta-analysis, including 7219 people with diabetic foot ulcers. Hyperbaric oxygen treatment had a significantly higher healed ulcer (OR, 14.39; 95% CI, 4.02–51.52, p < 0.001), higher adverse event (OR, 2.14; 95% CI, 1.11–4.11, p = 0.02), lower mortality (OR, 0.22; 95% CI, 0.07–0.71, p = 0.01) and higher ulcer area reduction (MD, 23.39; 95% CI, 11.79–34.99, p < 0.001) compared to standard treatment in patients with diabetic foot ulcers. However, hyperbaric oxygen treatment and standard treatment had no significant difference in amputation (OR, 0.62; 95% CI, 0.22–1.75, p = 0.37), major amputation (OR, 0.59; 95% CI, 0.18–1.92, p = 0.38), minor amputation (OR, 0.64; 95% CI, 0.15–2.66, p = 0.54) and healing time (MD, −0.001; 95% CI, −0.76 to 0.75, p = 0.99) in patients with diabetic foot ulcers. The examined data revealed that hyperbaric oxygen treatment had a significantly higher healed ulcer, adverse event, and ulcer area reduction and lower mortality, however, there was no significant difference in amputation and healing time compared to standard treatment in patients with diabetic foot ulcers. Yet, attention should be paid to its values since most of the selected examinations had a low sample size and some of the comparisons had a low number of selected studies.
FreshRSS