Comparative Cross-sectional Study Research Articles

Client Satisfaction and Associated Factors Among Insured and Uninsured Adult Clients Visiting Public Health Institution in Enrage Enawga Woreda, Amhara Regional State North West Ethiopia, 2021: Institution Based Comparative Cross Sectional Study

Background: Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for rural and urban populations. Knowing the factors for patient satisfaction is an important and direct indicator of quality of health care which is essential for providers to fill their gaps. Although few studies have been conducted on patient satisfaction in Ethiopia; but this study aimed to assess patient satisfaction and associated factors in the insured and uninsured clients under Community-based health insurance. Methods: Institution-based comparative cross-sectional study was conducted from March 15 th2021 to April 30th, 2021. Over all 770 clients were selected from the health center by using simple random sampling techniques. The data were coded and entered into Epi-data3.1 and exported to SPSS Version 25 for analysis. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed to identify the factors that affect client satisfaction with of p values less than 0.05. Results: Out of 753 respondents with a response rate of 97.8% the insured and non-insured patient satisfaction was 215 (56.6%) and 171(45.8%) respectively. The mean score with Standard Deviation of the satisfaction score was 3.6± 0.37 among insured and 3.5± 0.38 among non-insured under the CBHI scheme. The Pearson chi-square test showed a statistically significant difference between insured patients with a higher mean satisfaction score than their counterpart noninsured with x2= 8.67, df =1, P=0.003. Conclusions: The result shows that insured clients have a higher satisfaction score than non-insured clients. Therefore, to improve patient experiences at health centers and achieve financial risk protection through CBHI, program managers and healthcare providers should increase the satisfaction at the health facility to insured and non-insured community members.

Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients: comparative based cross-sectional study

BackgroundUncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups.MethodsA hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul’s Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05.ResultThe mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50–8.98), serum iron (AOR = 1.02, 95% CI(1.01–1.04), male gender (AOR = 0.16, 95% CI(0.05–0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07–0.95) were key associated factors for the elevated serum ferritin among T2DM patients.ConclusionThe present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.

Bacilli load in PTB- intestinal helminths co-infected and PTB non -infected patients at selected public health facilities in Jimma zone, Oromia, Ethiopia: comparative cross-sectional study

BackgroundTuberculosis (TB) and intestinal helminths are diseases that pose a dual burden on public health in low-income countries. Previous studies have shown that helminths can affect the shedding of bacteria or the bacterial load in the sputum of active TB patients. However, there is limited information on bacterial load in TB patients with helminth infections.ObjectiveThis study aimed to compare bacterial load in helminths-infected and non-infected pulmonary tuberculosis patients at selected public health facilities in Jimma zone, Oromia, Ethiopia.MethodsThe study was conducted in Jimma Zone, Oromia, Ethiopia. A facility-based comparative cross-sectional study was employed from August 01, 2020, to January 2021. A total of 124 (55 intestinal helminths-infected and 69 non-infected) newly diagnosed smear-positive pulmonary tuberculosis (PTB) patients were included in the study. A convenience sampling technique was employed to recruit study participants, and a semi-structured questionnaire was used to collect data regarding socio-demographic characteristics and possible risk factors for intestinal helminths co-infection. Stool examination was performed using both wet mount and Kato Katz technique. Additionally, weight and height measurements, sputum, and blood samples were taken to determine body mass index, bacilli load, and diabetic mellitus, respectively. Data were entered into Epi-Data software version 3.1 and analyzed using Statistical Packages for Social Sciences (SPSS) Version 25. A statistically significant difference was defined as a P-value of less than 0.05.ResultsIntestinal helminths reduced bacilli load 3 times more than intestinal helminths non-infected PTB (AOR = 3.44; 95% CI; 1.52, 7.79; P = 0.003) However, diabetes mellitus, HIV, drinking alcohol and cigarette smoking were not associated with bacilli load. The rate of co-infection TB with intestinal helminths was 44%. The three most prevalent parasites detected were Trichuris trichiura 29 (66%), hookworm 19 (43%), and Ascaris lumbricoides 11(25%)). Among co-infected patients about 36 (81.8%) had a single parasite infection, and 19 (43.2%) had multiple infections. A body mass index < 18.5 (AOR = 3.26; 95% CI; 1.25, 8.56;P = 0.016) and untrimmed fingernail status (AOR = 3.63; 95%CI;1.32,9.93;P = 0.012) were significantly associated with PTB- intestinal helminth –co-infection.ConclusionHelminth infection was associated with a lower bacilli load compared to helmenths non-infected PTB. The rate of co-infection TB with intestinal helminths was 44%. Trichuris trichiura was the most prevalent helminth. Untrimmed fingernail and a body mass index were associated with PTB-intestinal helminth co-infection.

Hematological and Coagulation Factors in Term and Preterm Newborns of Mothers with Pre-eclampsia

Objective: Pre-eclampsia (preE) is pregnancy-induced hypertension affecting a significant proportion of pregnant women worldwide and can cause detrimental effects on the mother and newborn. Recognition of contributing factors of health in neonates with pre-eclamptic mothers is important to reduce the burden of the problem. The aim of the study was to determine the hematologic and coagulation factors in term and preterm neonates born to mothers with pre-eclampsia. Method and Materials: In this observational cross-sectional comparative study, 104 neonates born to mothers with pre-eclampsia in Imam-Hossein Hospital from 2018 to 2021 were enrolled. The neonates were divided into term and preterm groups according to the gestational age of the mothers. Maternal and fetal parameters of neonates were collected. The hematologic and coagulation factors were recorded and compared. Results: The finding of the study demonstrated that the mean leukocyte (P=0.030), hemoglobin (P=0.0001), and platelet (P=0.0001) were significantly higher in term neonates. The mean PT (P=0.003), PPT (P=0.001), and INR (P=0.003) were significantly higher in preterm cases. Conclusion: Totally, according to the obtained results it may be concluded that CBC indexes and coagulopathy in term and preterm neonates born to mothers with pre-eclampsia are significantly different.

Polycyclic aromatic hydrocarbons (PAHs) in blood serum of adults living in high and low-traffic volume areas in Malaysia: A comparative cross-sectional study

Ambient polycyclic aromatic hydrocarbons (PAHs) originate predominantly from fuel combustion of motor vehicles and have the potential to affect human health. However, there is insufficient knowledge regarding serum PAHs health risks among the Malaysian population. This study aims to compare PAH concentrations, distributions, correlations, and health risks in 202 blood serum samples drawn from residents living in high-traffic volume areas (Kuala Lumpur) and low-traffic volume areas (Hulu Langat) in Malaysia. Solid phase extraction and gas chromatography-mass spectrometry (GC-MS) were employed to extract and analyze blood serum samples. Questionnaires were distributed to obtain sociodemographic and contributing factors of serum PAHs. The mean total PAHs concentration in serum of the Kuala Lumpur group was 54.44 ng g−1 lipids, double the Hulu Langat group's concentration (25.7 ng g−1 lipids). Indeno(1,2,3-cd)pyrene (IcP) and acenaphthene (ACP) feature the most and least abundant compounds in both study groups. The mean concentrations of IcP and ACP in the Kuala Lumpur and Hulu Langat groups were 26.8 vs 12.68 and 0.27 vs 0.14 ng g−1 lipids, respectively. High-molecular-weight PAHs (HMW-PAHs) composed 85% of serum total PAHs in both groups. Significant correlations were found (i) between the individual serum PAH congeners (p < 0.01) and (ii) between serum PAHs and total lipids (p < 0.01). According to the questionnaire data, high traffic volume and outdoor hobbies were the only contributory factors that confirmed significant relationships with serum PAHs (p < 0.001). Health risk assessment was computed using benzo(a)pyrene (BaP) equivalent (BaPeq) and demonstrated that the Kuala Lumpur group has twofold greater carcinogenic risk than the Hulu Langat group (16.11 vs 7.76 ng g−1 lipids). Our study reveals that traffic volumes notably impact serum PAH levels and general health among the Malaysian population.

Comments on the methods of “Effect of knee pain on muscles imbalance and physical limitation in individuals with bilateral knee osteoarthritis: A comparative cross-sectional study”

Comments on the methods of “Effect of knee pain on muscles imbalance and physical limitation in individuals with bilateral knee osteoarthritis: A comparative cross-sectional study”

Health-related quality of life in older hematological cancer survivors (70+) compared to older general population-A German cancer-register-based cross-sectional comparative study.

The extent of health-related quality of life (HRQOL) impairments in older hematological cancer survivors (HCS) has not been sufficiently studied. We therefore examined HRQOL in older HCS compared to a community sample (CS) and investigated sociodemographic, disease- and treatment-specific, geriatric, and psychosocial factors associated with reduced HRQOL. In this cancer-register-based cross-sectional comparative study 200 HCS, aged ≥70 years, and 252 persons of an age- and gender-matched CS completed validated questionnaires including the EORTC QLQ-C30 and EORTC QLQ-ELD14. Older HCS reported a reduced HRQOL in the dimensions of global QOL, physical, role, and social functioning (small clinical significance) and higher symptom burden of fatigue, nausea and vomiting, appetite loss, and poorer mobility compared to the CS (fatigue and mobility with medium, the others with small clinical significance). Perceived disease burden of comorbidities, functional disabilities, psychological distress, and depression showed statistical significance for reduced HRQOL in older HCS in multiple linear regression analysis (R2 = .602, p < .001). The screening and treatment of functional limitations and individual symptoms and the integration of a geriatric assessment into oncological practice can help to identify supportive care needs, to implement individualized, patient-centered cancer survivorship care programs and to improve older HCS's HRQOL.

Premenstrual syndrome among medical versus non-medical workers and its association with work-related quality of life

BackgroundPremenstrual syndrome (PMS) is a commonly underestimated disorder that negatively impacts a woman’s life. Medical workers, who live a more stressful life, may report an increased rate of PMS. Studies on the relationship between PMS and work-related quality of life for medical professionals are scarce, particularly in the Arab world. This study aimed to compare the frequency of PMS among medical versus non-medical workers at Zagazig University and to assess the association between PMS and their work-related quality of life.MethodsA comparative cross-sectional study was conducted. The sample population consisted of 48 medical and 48 non-medical female workers aged 18–45 years from Zagazig University. The two groups filled out a questionnaire with 3 parts: sociodemographic and occupational data, the Premenstrual Symptoms Screening Tool (PSST), and the Work-Related Quality of Life Scale (WRQL).ResultsSevere PMS was reported in 45.8% of medical workers versus 20.8% of non-medical workers with a statistically significant difference between both groups (p = 0.009). Binary logistic regression showed that being a medical worker, clinical specialty, ≥ 8 years of work, ≥ 24 working hours per week, and having a non-set hourly schedule were predictors for severe PMS. PMS was found to be a statistically significant predictor of poor WRQL (p < 0.001). There was a highly significant negative correlation between the PMS score and the WRQL score (r = − 0.302, p < 0.001).ConclusionAmong medical workers, PMS is more common and more severe, and WRQL is worse and negatively correlated with PMS. We suggest further studies with larger samples to prove this association and planning for public health programs to screen for and manage PMS among medical workers in our community.

Efficacy of the Different Statins and Combination Therapies With Non-Statin Agents on Serum Lipid Profiles in a Cohort With Established Atherosclerotic Cardiovascular Disease: A Comparative Cross-Sectional Study in a Single Centre

Efficacy of the Different Statins and Combination Therapies With Non-Statin Agents on Serum Lipid Profiles in a Cohort With Established Atherosclerotic Cardiovascular Disease: A Comparative Cross-Sectional Study in a Single Centre

The potential of ChatGPT in medicine: an example analysis of nephrology specialty exams in Poland.

In November 2022, OpenAI released a chatbot named ChatGPT, a product capable of processing natural language to create human-like conversational dialogue. It has generated a lot of interest, including from the scientific community and the medical science community. Recent publications have shown that ChatGPT can correctly answer questions from medical exams such as the United States Medical Licensing Examination and other specialty exams. To date, there have been no studies in which ChatGPT has been tested on specialty questions in the field of nephrology anywhere in the world. Using the ChatGPT-3.5 and -4.0 algorithms in this comparative cross-sectional study, we analysed 1560 single-answer questions from the national specialty exam in nephrology from 2017 to 2023 that were available in the Polish Medical Examination Center's question database along with answer keys. Of the 1556 questions posed to ChatGPT-4.0, correct answers were obtained with an accuracy of 69.84%, compared with ChatGPT-3.5 (45.70%, P=.0001) and with the top results of medical doctors (85.73%, P=.0001). Of the 13 tests, ChatGPT-4.0 exceeded the required ≥60% pass rate in 11 tests passed, and scored higher than the average of the human exam results. ChatGPT-3.5 was not spectacularly successful in nephrology exams. The ChatGPT-4.0 algorithm was able to pass most of the analysed nephrology specialty exams. New generations of ChatGPT achieve similar results to humans. The best results of humans are better than those of ChatGPT-4.0.

Client's satisfaction with healthcare services received at the hospital outpatients department and the primary healthcare facilities in Al-Qassim, Saudi Arabia: A review of service users' satisfaction.

To assess the level of satisfaction expressed for services rendered in the public health sector to clients who were seen at outpatient departments (OPDs) and primary healthcare (PHC) facilities in Al-Qassim Health Cluster in Saudi Arabia. This study used a comparative cross-sectional study design, and data were obtained as secondary data from The Patient's Experience Platform. Data analysis was carried out using Stata (version 16), and the significance level was 5%. In comparing the mean satisfaction in 9 domains, statistically significantly higher means for the PHC facilities than the OPDs were seen across 7 domains: patients navigating health facilities (p=0.008), nursing services (p<0.001), physicians' services (p=0.004), radiological services (p<0.001), personal issues (p=0.003), the pharmacy (p=0.005), and general experience (p=0.036). This study's findings are significant. They indicate that client satisfaction with services at PHC facilities was significantly higher than with services at hospital OPDs in Al-Qassim region. This underscores the need to improve the quality of services provided at OPDs to bring them to the same level as those provided by PHC facilities. Policymakers and implementers should, therefore, sustain efforts to make OPDs and PHC facilities more desirable for clients.

Breaking bad news: Comparing the perception of the role, barriers and experiences of neonatal intensive care and well-baby nursery nurses.

Nurses accompany patients throughout the breaking bad news process. The aim of the research was to compare neonatal intensive care unit (NICU) nurses and well-baby nursery (WBN) nurses on their role, barriers and experiences in breaking bad news to parents/relatives during hospitalization. A cross-sectional comparative study. Two medical centres in Israel were employed. A 39-item questionnaire was distributed with 140 nurses participating in the study. STROBE Checklist was used. A total of 140 nurses participated in this study. There was no significant overall difference (p ≤ .45) between NICU and WBN nurses in their perception of their role in breaking bad news. Differences were found in barriers to the role which included a lack of information, lack of time and communication issues. No differences were found in the nurses' experiences in breaking bad news. NICU and WBN nurses reported that they received no support (n = 40, 58.8%; n = 45, 64.3%, respectively). No breaking bad news specialty team existed in either unit (NICU: n = 64, 91.4%; n = 60, 87.0%). Nurses in the WBN and NICU are involved in breaking bad news. The role of the nurse has not been fully acknowledged making it difficult to perform. Nurses' experiences in breaking bad news were varied. Nurses facing challenges should be provided guidance and support. This needs to be implemented. The role played by nurses in breaking bad news has not been fully acknowledged making it difficult to perform. Nurses need to receive formal training and support in order to improve this practice.

Validity of Serum Ammonia Level for Diagnosis of Severity of Hepatic Encephalopathy in Children

Hepatic encephalopathy is a broad spectrum neuropsychiatric abnormalities of liver dysfunction. Ammonia level may correlate with the severity of liver failure. The brain is very sensitive to the toxic effects of ammonia. As a result patient may manifests with irritability, slurring of speech, reversal of sleep-awake cycle, flapping tremor, confusion, stupor or even deep coma. This study was aimed to validate the ammonia level in children with liver failure for the assessment of its severity considering hepatic encephalopathy. This cross-sectional comparative study was conducted among 64 children aged 1-15 years of both sexes (study subjects) diagnosed as acute or acute on chronic liver failure in the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of November 2017 to September 2019. The subject were divided into two groups for the comparison of ammonia level to assess the severity in contrast to hepatic encephalopathy. In the first group 32 were liver failure with encephalopathy and in the second group 32 were liver failure without encephalopathy. Hepatic encephalopathy was diagnosed on the basis of West Haven Criteria. The analysis was done by the Receiver Operating Characteristic Curve with SPSS-20. Among the 64 patients female were 45% whereas male patients were 55%, male female ratio was 1.2: 1. Regarding etiology, Wilson disease was the most common cause and it was nearly two-third (65.6%) of children, cryptogenic cirrhosis was 10%, Hepatitis A was 9.4%, Autoimmune Hepatitis (AIH) was 3.10%, Hepatitis E, Hepatitis B, Hepatitis C, biliary atresia and lipid storage were 1.60% respectively. This study showed that, ammonia of ≥71 µmol/L is an indicator for presence of hepatic encephalopathy in children. The analysis by the Receiver Operating Characteristic Curve showed area under the curve (AUC) is 0.86 with upper bound 0.96 and lower bound is 0.77. It was observed that about half (48.4%) of the children had positive blood ammonia level (≥71.0 umol/L) and among the children of positive blood ammonia level most of them (80.65%) had hepatic encephalopathy and 19.35% had no encephalopathy. More than half (51.6%) children had negative (&lt;71.0 umol/L) blood ammonia level, among them 21.21% children had encephalopathy and 78.79% patients had no encephalopathy. Sensitivity of blood ammonia was found 78.1%, specificity 81.2%, positive predictive value 80.6%, negative predictive value 78.8% and accuracy 79.7%. In conclusion, high level of ammonia is found with higher grade of encephalopathy and hyperammonia is also found in liver failure without encephalopathy. Bangladesh Med J. 2023 May; 52(2): 1-5

Assessing the shade matching accuracy among dental students through visual and instrumental methods

Objectives: To evaluate the shade selection accuracy of male dental students according to the three dimensions of color: value, hue, and chroma, using visual and instrumental shade selection methods under different lighting conditions. Methods: This comparative cross-sectional study was instigated amongst 70 male 4th, 5th, and 6th years BDS students of the Dental Clinics Complex at King Faisal University, Saudi Arabia for a duration of two months. First, the principal investigator determined the shade of tooth 11 and 46 on patient utilizing the spectrophotometer after calibration. In the next step, students were asked to select the shade of same tooth 11 and 46 using VITA 3D-Master shade guide under clinic lightening condition and corrected light. The characteristics of the color such as hue, chroma and value were recorded. The Kruskal-Wallis test was applied to find the significant difference in shade selection between visual and instrumental methods with respect to academic years. Results: The mean of the value of instrumental shade selection of tooth # 46 was slightly higher among 4th year students (4.41±0.73), than that of 5th year (3.72±1.02), and 6th year students (3.83±0.83), with a statistically significant difference among them (p= 0.024), indicating 6th year students selected darker shades. Additionally, a statistically significant relationship was noticed among 4th, 5th, and 6th year students with respect to the means of the chroma of 2.18 ±1.29, 2.92±1.11, and 3.13±1.10, respectively (p= 0.025). Conclusion: The selection of posterior teeth shades was notably influenced by academic years, employing both instrumental and visual methods, while considering color parameters. doi: https://doi.org/10.12669/pjms.40.8.9491 How to cite this: Ahmed MA. Assessing the shade matching accuracy among dental students through visual and instrumental methods. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.9491 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparison between the outcome of pancreaticogastrostomy and pancreaticojejunostomy after pancreaticoduodenectomy: a cross-sectional study

Background: Complications of pancreatic stump reconstruction after pancreaticoduodenectomy (PD) can lead to severe morbidity or even mortality. This study is taken to see the postoperative outcome of pancreatico-gastrostomy (PG) over pancreaticojejunostomy (PJ) after PD. Aim of the study was to compare the outcomes of PG and PJ following PD in a cross-sectional analysis. Methods: This comparative cross-sectional study was done in the department of hepatobiliary pancreatic and liver transplant surgery, BSMMU, Dhaka. A total of twenty-five patients (N=25), who underwent PD from July 2019 to June 2020, were included in this study. These patients were divided into two group, group A with PG (n=10) and group B with PJ (n=15). All patients were evaluated before and after surgery for assessing post-operative outcome by clinically, biochemically and radiologically. Results: This study showed no significant differences in demographic characteristics, co-morbidity and post-operative outcomes/complications between this two groups. However, PG demonstrated significantly shorter anastomosis time and required fewer sutures than PJ. Although a higher incidence of wound infections was observed in PJ compared to PG, these differences were not statistically significant. Peri-operative mortality did not significantly differ between the two techniques. Though postoperative hospital stay was shorter in the PG group compared to PJ but the difference was not statistically significant. Conclusions: PG can be considered as a safe and alternative procedure after PD.

Pediatric asthma knowledge: Insights from a Portuguese central hospital study.

Asthma is a common chronic condition in children, with parental and child health literacy affecting health outcomes and asthma control. This study examined pediatric asthma knowledge at a Portuguese central hospital and its determinants. We conducted a comparative cross-sectional study, applying the Asthma Knowledge Questionnaire (QCSA), answered by adolescents and/or caregivers. The sample was categorized into two groups based on the presence or absence of respiratory conditions, such as asthma or recurrent wheezing, in children. Those with such conditions (Group A) were further divided into two subgroups: those receiving general pediatric care (Group A2) and those receiving specialized care, followed in pulmonology or allergology consultations (Group A1). The study involved 154 participants, predominantly female (74%) with an average age of 31.2 years ( ± 13.4). The average QCSA score was 14.8 ( ± 3.2), and Group A exhibited a statistically higher score, 15.5 points ±3.2 versus Group B, 14.2 points ± 3.2, p = .034. Group A1 achieved significantly better scores (16 points: range 4-21) than Group A2 (14 points: range 9-21) (p = .029). Scores were correlated positively with the duration of specialized follow-up (ρ = .326; p = .027). Asthma knowledge was correlated with the level of education (r = .468; p < .001). The number of wheezing episodes (r = -.466; p < .001) within the past year were associated to QCSA scores. In summary, the presence of respiratory condition, the follow-up in specialized appointments and higher levels of education were associated with greater asthma knowledge.

HIV-related cognitive disorders in children in Kinshasa (Democratic Republic of Congo)

ObjectivesHIV-infected individuals are at increased risk of neurocognitive disorders compared with the general population. Studies suggest that, despite the combination of antiretroviral drugs, HIV infection causes immune activation leading to significant neural damage; however, there is little data on HIV-infected young people in our country.MethodologyThis is a comparative cross-sectional study conducted between November 2020 and March 2021 on two hundred and sixteen children aged 6–15 years, including 106 HIV-positive children and 108 healthy children. Cognitive performance was assessed using the Differential Ability Scale Second Edition (DAS-II).ResultsHIV-infected children showed lower cognitive scores than control children in the subtest group of verbal ability (82.1% vs. 43.5%); non-verbal ability (84.9% vs. 45.4%); spatial ability (79.2% vs. 21.3%) and generall conceptual ability (GCA) (88.7% vs. 43.5%). The children in the control group had significantly higher ability scores in the diagnostic tests and in school achievement, and the difference was statistically significant.ConclusionCognitive impairment remains a significant complication in HIV-positive children, as suggested by low cognitive scores in more than half of our participants. This is an unresolved issue with implications for survival, quality of life and daily functioning in these children. It is important that clinicians are able to identify and manage these cognitive deficits.

The role of community health and nutrition volunteers in improving the health and nutrition status of infant and young children in remote areas, Hajjah, Yemen

BackgroundIn Yemen, morbidity and malnutrition are major public health problems. The Community Health and Nutrition Volunteers (CHNVs) program was launched to tackle these problems through providing services to mothers and their children residing in remote villages. Since establishment of the CHNVs program in Yemen, its outcome has never been evaluated. Therefore, the aim of this study was to assess the role of CHNVs in improving the immunization, morbidity and nutritional status of infant and young children (IYC).MethodsA comparative cross-sectional study design was conducted in Al-Maghrabah and Bani-Qais districts, Hajjah governorate. It was carried out between January and April 2023. A three-stage cluster sampling method was used. A total of 926 IYC with their mothers were interviewed using a pre-tested questionnaire. SPSS 26 was used for data analysis. The multinomial logistic regression and chi-square or fisher exact tests were used to compare the vaccination, morbidity and nutritional status of IYC between the volunteer and non-volunteer villages. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. A p value < 0.05 was considered statistically significant.ResultsThe IYC in volunteer villages were more likely to be fully or partially vaccinated compared to those in non-volunteer villages [OR = 2.3, 95% CI: 1.5–3.7, p < 0.0001, and OR = 1.9, 95% CI: 1.3–2.8, p = 0.001, respectively]. The specific coverage rates for BCG, and the 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines were significantly higher in the volunteer compared to non-volunteer villages [(OR = 1.8, 95% CI: 1.3–2.5, p < 0.0001), (OR = 1.5, 95% CI: 1.2–2.1, p = 0.003), and (OR = 1.5, 95% CI: 1.2-2.0, p = 0.002), respectively]. Moreover, the prevalence of diarrhea and fever among IYC was significantly lower in the volunteer compared to non-volunteer villages [(OR = 0.7, 95% CI: 0.5–0.9, p = 0.004) and (OR = 0.7 95% CI: 0.5–0.9, p = 0.045), respectively].ConclusionsThe study found that CHNVs play a significant role in improving vaccination status and the coverage rate for BCG, and 1st and 2nd doses of OPV/Pentavalent/Pneumo/Rota vaccines, and reducing the prevalence of diarrhea and fever among IYC in their villages compared to non-volunteer villages, in Hajjah governorate. Future follow-up study and expansion to other settings in different governorates is recommended.

Relationship of sociodemographic and clinical characteristics to mechanical restraint used in a psychiatric hospital in Spain.

Coercive measures have been applied in mental health fields throughout history, denying people with mental illness the ability to decide, even though there is increasing evidence that these measures bring few benefits to these individuals. The objective of this study was to analyse the sociodemographic and clinical characteristics most likely associated with the use of mechanical restraints (MRs) in psychiatric hospital settings. This was a descriptive, comparative and analytical cross-sectional study in people with mental disorders who were hospitalized in two hospitals in the Autonomous Valencian Community (Spain). We included a total of 91 participants who completed the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS), Barrat's Impulsiveness Scale and the Hamilton Anxiety Scale. The results we collected indicated that the patients most likely to be mechanically restrained were younger people with less awareness of their symptoms and disease, previous admissions to a psychiatric hospital and cohabitation with parents and/or family. In addition, having been admitted involuntarily, previously having had MRs applied, presenting more positive psychotic symptoms and habitual caffeine consumption all predicted the use of MRs. The variables that were able to predict MR were involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Evaluation of the sociodemographic and clinical characteristics of patients can help health professionals, especially nurses, to recognize patients who are at risk of requiring MR. This allows mental health practitioners to take these factors into account during interventions or when implementing programmes designed to reduce the use of coercive measures in psychiatric hospital settings. What problem did the study address? Coercive measures have been applied in mental health fields throughout history, with no benefits to these patients. What were the main findings? There are studies that relate some variables to MR in psychiatric settings, but we have been able to find variables capable of predicting MR such as involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Where and on whom will the research have an impact? The findings of this study allow for the reduction of MRs in psychiatric units. The sociodemographic and clinical characteristics found to be related to MR will help professionals identify when a patient is admitted in order to use specific interventions aimed at preventing the use of MRs during admission. This is the first study to indicate a relationship between caffeine consumption and the use of MRs. Further studies will be necessary to verify if controlled caffeine supplementation during admission to psychiatric units could become an additional strategy contributing to preventing the application of MR specifically in individuals who habitually consume coffee or caffeine-containing beverages daily. We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. No patient or public contribution.

CELF4 (rs1786814) gene polymorphism and speckle-tracking Echocardiography for cardiovascular complications in childhood cancer survivors.

Despite a well-known dose-dependent association between the risk of cardiac dysfunction and anthracycline, the risk of cardiac dysfunction for any given anthracycline dose varies between patients. So, we assessed CELF4 (rs1786814) gene polymorphism on anthracycline-related cardiotoxicity in childhood cancer survivors (CCS). This comparative cross-sectional study included 53 CCS who had regular follow-up visits at the Pediatric Oncology Unit, Menoufia University Hospital. CELF4 (rs1786814) gene polymorphism and conventional and speckle-tracking Echocardiography were done for all survivors. Regarding CELF4 (rs1786814) genotypes, significant differences existed between the studied groups with a predominance of GG homozygous mutation. For Echocardiographic findings, the ejection fraction and end-systolic diameter compared to the control group, were significantly lower in the survivors group. Speckle- tracking Echocardiography showed a significant difference regarding (GLPS-A4C) and (GLPS-LAX), with no significant difference regarding (GLPS-A2C), (GLPS-Avg) and left atrium between the studied groups. Multivariate logistic regression analysis illustrated a statistically significant relation between cumulative anthracycline dose >300 mg/m2 and CLEF4 (rs1786814) genotypes (GG and GA) and the risk of cardiotoxicity with more significance in GG mutation. Early detection of ventricular dysfunction in CCS with subclinical cardiotoxicity with regular follow-up is promising before the development of life-threatening complications. Early detection of anthracycline-related cardiotoxicity in childhood cancer survivors (CCS) after finishing chemotherapy. CLEF4 (rs1786814) GG variant is more significant in CCS exposed to high-dose anthracycline. GLPS holds promise as an early predictor of late left ventricular dysfunction and subclinical cardiotoxicity in CCS.