Epidemiology of uterine rupture among pregnant women in China and development of a risk prediction model: analysis of data from a multicentre, cross-sectional study

ObjectivesTo describe the epidemiology of uterine rupture in China from 2015 to 2016 and to build a prediction model for uterine rupture in women with a scarred uterus.SettingA multicentre cross-sectional survey conducted in 96 hospitals across China in 2015–2016.ParticipantsOur survey initially included 77 789 birth records from hospitals with 1000 or more deliveries per year. We excluded 2567 births less than 24 gestational weeks or unknown and 1042 births with unknown status of uterine rupture, leaving 74 180 births for the final analysis.Primary and secondary outcome measuresComplete and incomplete uterine rupture and the risk factors, and a prediction model for uterine rupture in women with scarred uterus (assigned each birth a weight based on the sampling frame).ResultsThe weighted incidence of uterine rupture was 0.18% (95% CI 0.05% to 0.23%) in our study population during 2015 and 2016. The weighted incidence of uterine rupture in women with scarred and intact uterus was 0.79% (95% CI 0.63% to 0.91%) and 0.05% (95% CI 0.02% to 0.13%), respectively. Younger or older maternal age, prepregnancy diabetes, overweight or obesity, complications during pregnancy (hypertensive disorders in pregnancy and gestational diabetes), low education, repeat caesarean section (≥2), multiple abortions (≥2), assisted reproductive technology, placenta previa, induce labour, fetal malpresentation, multiple pregnancy, anaemia, high parity and antepartum stillbirth were associated with an increased risk of uterine rupture. The prediction model including eight variables (OR >1.5) yielded an area under the curve (AUC) of 0.812 (95% CI 0.793 to 0.836) in predicting uterine rupture in women with scarred uterus with sensitivity and specificity of 77.2% and 69.8%, respectively.ConclusionsThe incidence of uterine rupture was 0.18% in this population in 2015–2016. The predictive model based on eight easily available variables had a moderate predictive value in predicting uterine rupture in women with scarred uterus. Strategies based on predictions may be considered to further reduce the burden of uterine rupture in China.

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Challenges facing essential workers: a cross-sectional survey of the subjective mental health and well-being of New Zealand healthcare and ‘other’ essential workers during the COVID-19 lockdown

BMJ Open ◽

10.1136/bmjopen-2020-048107 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048107

Author(s):

Caroline Bell ◽

Jonathan Williman ◽

Ben Beaglehole ◽

James Stanley ◽

Matthew Jenkins ◽

...

Keyword(s):

Psychological Distress ◽

New Zealand ◽

Alcohol Use ◽

Well Being ◽

Secondary Outcome ◽

Essential Work ◽

Work Roles ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk

ObjectivesTo compare psychological outcomes, experiences and sources of stress over the COVID-19 lockdown in New Zealand in essential workers (healthcare and ‘other’ essential workers) with that of workers in nonessential work roles.DesignOnline cross-sectional survey.SettingConducted in New Zealand over level 4 lockdown in April/May 2020.ParticipantsFindings from employed participants (2495) are included in this report; 381 healthcare workers, 649 ‘other’ essential workers and 1465 nonessential workers.Primary and secondary outcome measuresMeasures included psychological distress (Kessler Psychological Distress Scale (K10)), anxiety (Generalised Anxiety Disorder (GAD-7)), well-being (WHO-5), alcohol use, subjective experiences and sources of stress. Differences between work categories were quantified as risk ratios or χ2 tests.ResultsAfter controlling for confounders that differed between groups of essential and nonessential workers, those in healthcare and those in ‘other’ essential work were at 71% (95% CI 1.29 to 2.27) and 59% (95% CI 1.25 to 2.02) greater risk respectively, of moderate levels of anxiety (GAD-7 ≥10), than those in nonessential work. Those in healthcare were at 19% (95% CI 1.02 to 1.39) greater risk of poor well-being (WHO-5 <13). There was no evidence of differences across work roles in risk for psychological distress (K10 ≥12) or increased alcohol use. Healthcare and ‘other’ essential workers reported increased workload (p<0.001) and less uncertainty about finances and employment than those in nonessential work (p<0.001). Healthcare and nonessential workers reported decreased social contact. No difference by work category in health concerns was reported; 15% had concerns about participants’ own health and 33% about other people’s health.ConclusionsDuring the pandemic lockdown, essential workers (those in healthcare and those providing ‘other’ essential work) were at increased risk of anxiety compared with those in nonessential work, with those in healthcare also being at increased risk of poor well-being. This highlights the need to recognise the challenges this vital workforce face in pandemics.

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Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults

BMJ Open ◽

10.1136/bmjopen-2018-026532 ◽

2019 ◽

Vol 9 (9) ◽

pp. e026532 ◽

Cited By ~ 2

Author(s):

Yanan Luo ◽

Lei Zhang ◽

Ping He ◽

Lihua Pang ◽

Chao Guo ◽

...

Keyword(s):

Socioeconomic Status ◽

National Sample ◽

Sample Survey ◽

Secondary Outcome ◽

Low Ses ◽

Chinese Adults ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Individual Level ◽

Increased Risk

ObjectivesHealth disparities in schizophrenia are well established. However, it is less understood whether area-level socioeconomic status (SES) is differentially associated with schizophrenia depending on individual-level SES. Therefore, using a nationally large representative data, this study investigated the association between individual-level SES, area-level SES and their interaction with schizophrenia in Chinese adults from a multilevel perspective.SettingHousehold interviews in 734 counties (districts), 2980 towns (streets) and 5964 communities (villages) from 31 provinces, People's Republic of China, as part of the cross-sectional survey of Second China National Sample Survey on Disability.Participants1 909 205 men and women aged 18 years old and above.Primary and secondary outcome measuresA screen followed by clinical diagnosis was used to identify schizophrenia, and schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision (code F20).Results1-SD increase in individual SES was associated with decreased risk of schizophrenia (OR=0.45,95% CI0.43 to 0.46). 1-SD increase in area-level SES was associated with increased risk of schizophrenia (OR=1.30,95% CI1.24 to 1.37). The interaction of individual SES and area-level SES was statistically significant (OR=1.05,95% CI1.02 to 1.08); as the level of area SES increased, schizophrenia risk of lower SES people grew faster than the risk of higher SES people.ConclusionsArea-level SES is particularly important to mental health of low SES individuals, with low SES people in high SES counties having the highest risk of schizophrenia than other groups. Action to reduce SES disparities in schizophrenia will require attention to the area-level context of low SES adults.

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Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽

10.1136/bmjopen-2020-047757 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047757

Author(s):

Heba AlSawahli ◽

Caleb D Mpyet ◽

Gamal Ezzelarab ◽

Ibrahim Hassanin ◽

Mohammad Shalaby ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Rapid Assessment ◽

Good Control ◽

Population Based ◽

Secondary Outcome ◽

Public Health Approach ◽

Eye Care ◽

Cross Sectional Survey ◽

Prevalence Survey ◽

Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

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Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094679 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4679

Author(s):

Ta-Chuan Yeh ◽

Ya-Mei Bai ◽

Shih-Jen Tsai ◽

Tzeng-Ji Chen ◽

Chih-Sung Liang ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Mental Disorders ◽

Autism Spectrum ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Early Implementation ◽

Increased Risk ◽

Nationally Representative ◽

Irritable Bowel

Irritable bowel syndrome (IBS) is a functional bowel disorder that is highly comorbid with mental disorders. However, few studies have examined the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), and schizophrenia in the offspring of parents with IBS. We used nationally representative cross-sectional survey data to analyze cross-generational transmission patterns of both IBS and major mental disorders. Odds ratio (OR) was calculated by using logistic regression models with adjustment for potential confounding factors. Offspring of parents with IBS were more likely to develop IBS themselves (OR = 2.41, 95% confidence interval (CI), 2.09–2.78), ADHD (OR = 1.33, 95% CI, 1.08–1.62), and MDD (OR = 1.32, 95% CI, 1.04–1.68) than the controls. Data stratification by parental sex revealed that paternal IBS increased risk of ADHD (OR = 1.34, 95% CI, 1.01–1.77) in the offspring, while maternal IBS increased the risk of MDD (OR = 1.51, 95% CI, 1.11–2.06). This is the first study to reveal parental IBS is associated with IBS, ADHD, and MDD among offspring, suggesting the necessity for early implementation of prevention strategies for at-risk children.

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ASSOCIATION BETWEEN CELL PHONE USAGE AND MUSCULOSKELETAL DISORDERS IN SCHOOL GOING CHILDREN

Journal of Musculoskeletal Research ◽

10.1142/s0218957722500038 ◽

2021 ◽

Author(s):

Sujata Mandhwani ◽

Sadaf Zia ◽

Emad Salman Shaikh ◽

Dante Duarte ◽

Erum Tanveer

Keyword(s):

Musculoskeletal Disorders ◽

Cell Phone ◽

Smart Phone ◽

Sampling Technique ◽

The Body ◽

Camera Phone ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Increased Risk ◽

Margin Of Error

The adverse effects of excessive mobile phone (MP) use on children include deprivation from sleep, increased risk of lack of concentration, depression, anxiety and obesity. No such study has been conducted in children from Pakistan. Objectives: To assess the association of MP usage and musculoskeletal disorders in school going children. Methods: This was a cross sectional survey. Data were collected from different private schools of Karachi, Pakistan. Convenient non probability sampling technique was used. A sample size of 385 students was taken keeping a confidence interval of 95% with 5% margin of error. Results: A total of 385 subjects participated. It was also noticed that 75.6% (291) students have smart phone and 5.2% (20) have conventional phone and remaining 19.2% (74) have camera phone. It was noticed that the participants 306 (79.5%) said they slept for 1–2[Formula: see text]h daily and 30 (7.8%) had sleep for 3–4[Formula: see text]h daily. One hundred and four 104 (27%) had noticed pain in neck. Conclusion: The use of MP for any activity was associated with sleep deprivation and pain in wrist/hands followed by neck and upper back pain. The usage of MP should be limited to avoid the stress on musculoskeletal parts of the body.

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Healthcare Workers Preparedness for COVID-19 Pandemic in the Occupied Palestinian Territory: A Cross-sectional Survey

10.21203/rs.3.rs-112643/v1 ◽

2020 ◽

Author(s):

Osaid Alser ◽

Heba Alghoul ◽

Zahra Alkhateeb ◽

Ayah Hamdan ◽

Loai Albarqouni ◽

...

Keyword(s):

Healthcare Workers ◽

Gaza Strip ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Online Questionnaire ◽

Cross Sectional ◽

Occupied Palestinian Territory ◽

Governmental Institutions ◽

Palestinian Territory

Abstract Background: The coronavirus disease 19 (COVID-19) pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). Sufficient training of healthcare workers (HCWs) in managing COVID-19 and the provision of personal protective equipment (PPE) are essential in allowing oPt to mount a credible response to the crisis.Methods: A cross-sectional study was conducted using a validated online questionnaire between March 30, 2020 and April 12, 2020. Primary outcomes were availability of PPE and HCWs preparedness in oPt for COVID-19 pandemic. Secondary outcome was regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness.Results: Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) for isolation gowns. Most HCWs did not find eye protection (n=128, 92.8%), N95 respirators (n=132, 95.7%), and face shields (n=127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p=0.03) and gloves (p <0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions (p = 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol. Conclusion: HCWs in oPt are underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.

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Prevalence of anxiety and depressive symptoms and impact on self-management among adults with chronic conditions in Chicago, Illinois, USA, during the COVID-19 pandemic: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2021-052495 ◽

2022 ◽

Vol 12 (1) ◽

pp. e052495

Author(s):

Rebecca M Lovett ◽

Lauren Opsasnick ◽

Andrea Russell ◽

Esther Yoon ◽

Sophia Weiner-Light ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

Chronic Conditions ◽

Least Square ◽

Self Management ◽

Secondary Outcome ◽

Measurement Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Reported

ObjectivesTo examine the prevalence of mental health symptoms during the first surge of COVID-19 in the USA, and their associations with COVID-19-related emotional distress, health self-management and healthcare utilisation.DesignCross-sectional analysis of wave 3 (1–22 May 2020) survey data from the ongoing Chicago COVID-19 Comorbidities (C3) study.SettingSeven academic and community health centres in Chicago, Illinois.Participants565 adults aged 23–88 with one or more chronic conditions completing at least one prior C3 study wave.Primary and secondary outcome measuresClinically relevant anxiety and depressive symptoms as measured using Patient-Reported Outcomes Measurement Information System short forms. Self-reported emotional and health-related responses to COVID-19 were measured through a combination of single-item questions and validated measures.ResultsRates of anxiety and depressive symptoms were 14% (81/563) and 15% (84/563), respectively. Anxiety and depressive symptoms were then each separately associated with greater worry about contracting COVID-19 (relative risk (RR) 2.32, 95% CI 1.52 to 3.53; RR 1.67, 95% CI 1.10 to 2.54), greater stress (RR 4.93, 95% CI 3.20 to 7.59; RR 3.01, 95% CI 1.96 to 4.61) and loneliness (RR 3.82, 95% CI 2.21 to 6.60; RR 5.37, 95% CI 3.21 to 8.98), greater avoidance of the doctor (RR 1.62, 95% CI 1.06 to 2.49; RR 1.54, 95% CI 1.00 to 2.36) and difficulty managing health (least square means (LS Means) 6.09, 95% CI 5.25 to 6.92 vs 4.23, 95% CI 3.70 to 4.75; LS Means 5.85, 95% CI 5.04 to 6.65 vs 4.22, 95% CI 3.70 to 4.75) and medications (LS Means 3.71, 95% CI 2.98 to 4.43 vs 2.47, 95% CI 2.02 to 2.92) due to the pandemic.ConclusionsIdentifying and addressing mental health concerns may be an important factor to consider in COVID-19 prevention and management among high-risk medical populations.

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Application of 23 novel serological markers for identifying recent exposure to Plasmodium vivax parasites in an endemic population of western Thailand

10.1101/2021.03.01.21252492 ◽

2021 ◽

Author(s):

Sadudee Chotirat ◽

Narimane Nekkab ◽

Chalermpon Kumpitak ◽

Jenni Hietanen ◽

Michael T White ◽

...

Keyword(s):

Plasmodium Vivax ◽

Spatial Clustering ◽

Surface Protein ◽

Merozoite Surface Protein ◽

Serological Markers ◽

Igg Antibody ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Recent Exposure ◽

Increased Risk

AbstractThailand is aiming for malaria elimination by the year 2030. However, the high proportion of asymptomatic infections and the presence of the hidden hypnozoite stage of Plasmodium vivax are impeding these efforts. We hypothesized that a validated surveillance tool utilizing serological markers of recent exposure to P. vivax infection could help to identify areas of ongoing transmission. The objective of this exploratory study was to assess the ability of P. vivax serological exposure markers to detect residual transmission ‘hot-spots’ in Western Thailand. Total IgG levels were measured against a panel of 23 candidate P. vivax serological exposure markers using a multiplexed bead-based assay. A total of 4255 plasma samples from a cross-sectional survey conducted in 2012 of endemic areas in the Kanchanaburi and Ratchaburi provinces were assayed. We compared IgG levels with multiple epidemiological factors that are associated with an increased risk of P. vivax infection in Thailand, including age, gender and spatial location, as well as Plasmodium infection status itself. IgG levels to all proteins were significantly higher in the presence of a P. vivax infection (n=144) (t test, p<0.0001). Overall seropositivity rates varied from 2.5% (PVX_097625, merozoite surface protein 8) to 16.8% (PVX_082670, merozoite surface protein 7), with 43% of individuals seropositive to at least 1 protein. Higher IgG levels were associated with older age (>18 years, p<0.05) and males (17/23 proteins, p<0.05), supporting the paradigm that men have a higher risk of infection than females in this setting. We used a Random Forests algorithm to predict which individuals had exposure to P. vivax parasites in the last 9-months, based on their IgG antibody levels to a panel of 8 previously validated P. vivax proteins. Spatial clustering was observed at the village and regional level, with a moderate correlation between PCR prevalence and sero-prevalence as predicted by the algorithm. Our data provides proof-of-concept for application of such surrogate markers as evidence of recent exposure in low transmission areas. These data can be used to better identify geographical areas with asymptomatic infection burdens that can be targeted in elimination campaigns.

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Depression and Anxiety Plus Levels of Stress among Secondary School Students during the COVID-19 Lockdown: an Online CrossSectional Survey

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.2021824 ◽

2021 ◽

Author(s):

Gunn Pungpapong ◽

Rasmon Kalayasiri

Keyword(s):

Substance Use ◽

Secondary School ◽

Secondary School Students ◽

Female Gender ◽

Depression And Anxiety ◽

Cross Sectional Survey ◽

School Students ◽

Cross Sectional ◽

Increased Risk ◽

Patient Health

Objective: To assess prevalence and factors associated with depression, anxiety and stress among adolescents experiencing lockdown during the 2019 coronavirus disease 2019 (COVID-19) in both Asian and Western countries. Material and Methods: From May-June 2020, secondary school students were enrolled in an online cross-sectional survey, through social media; including, but not limited to, Instagram, Snapchat, WhatsApp and LINE. We assessed the presence and severity of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Scale-7) and stress (Perceived Stress Scale-10) within the last month, and assessed significant associations with demographics, degree of social distancing, and other associated issues using univariate and multivariate logistic regression analyses.Results: From 392 respondents (56.4% male, 43.1% female), from Thailand (59.2%), the United Kingdom (26.5%) and other countries (14.3%), we identified depressive symptoms in 58.7%, anxiety in 40.3% and high levels of stress in 9.7%. By multivariate analysis, we found significant associations between being female and depression and anxiety, being in late secondary school years and depression, and changes in patterns of substance use and anxiety and stress. Participants not located in Thailand had increased risk of depression.Conclusion: Our study demonstrated depression, anxiety and stress in six, four and one out of ten adolescents, respectively, who were experiencing lockdowns due to the COVID-19 pandemic. We found female gender, older school years, and changes in substance use patterns to be significantly associated with these mental health conditions.

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Exploring the therapeutic alliance in Belgian family medicine and its association with doctor–patient characteristics: a cross-sectional survey study

BMJ Open ◽

10.1136/bmjopen-2019-033710 ◽

2020 ◽

Vol 10 (2) ◽

pp. e033710 ◽

Cited By ~ 2

Author(s):

Pauline Boeckxstaens ◽

Annelou Meskens ◽

Aline Van der Poorten ◽

Anne-Catherine Verpoort ◽

Elizabeth Ann Sturgiss

Keyword(s):

Therapeutic Alliance ◽

Quality Of Healthcare ◽

Survey Study ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Family Doctors ◽

Patient Centred Care ◽

Clinical Method ◽

Age Range

ObjectivesPatient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient–doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance.DesignCross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient–doctor relationship.SettingBelgian primary care.ParticipantsEvery third patient (both practice and house call visits) was invited to participate. 170 patient–doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24–63 years) and 170 patients (35.9% men, age range 18–92 years).Primary and secondary outcome measuresPrimary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations).ResultsThe median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year.ConclusionsConsultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.

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