Publications by authors named "Akm Fazlur Rahman"

23 Publications

  • Page 1 of 1

Pragmatic estimations of obstetric fistula in Bangladesh.

Lancet Glob Health 2022 Sep;10(9):e1228-e1229

Centre for Injury Prevention and Research, Dhaka 1206, Bangladesh.

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http://dx.doi.org/10.1016/S2214-109X(22)00314-XDOI Listing
September 2022

Infant Safe Sleep Knowledge, Attitudes, and Behaviors by Physicians at an Academic Children's Hospital.

Clin Pediatr (Phila) 2022 Jun 27:99228221106750. Epub 2022 Jun 27.

Division of Pediatric Critical Care, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA.

Sudden unexpected infant death (SUID) is the leading cause of death for infants. Physician advice on safe sleep is an important source of information for families. We sought to evaluate the safe sleep knowledge, attitudes, and behaviors of physicians by distributing a cross-sectional survey at a freestanding children's hospital. The survey included demographics, knowledge items, attitudinal assessment, and frequency of providing safe sleep guidance. Multivariable linear regression and logistic regression were used to evaluate associations between variables. 398 physicians were surveyed with 124 responses (31%). Females, those who received safe sleep training, and those who see infants in daily practice had higher knowledge scores. Physicians with higher knowledge scores had more positive attitudes toward safe sleep and provided safe sleep education to patients more often. Our study underlies the importance of education and repeated exposure in forming positive attitudes toward safe sleep recommendations and leads to increased provision of safe sleep guidance.
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http://dx.doi.org/10.1177/00099228221106750DOI Listing
June 2022

Cardiac arrest during endotracheal intubation of children with systolic dysfunction.

Cardiol Young 2022 May 4:1-7. Epub 2022 May 4.

Division of Cardiology, Cardiac Intensive Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.

This multicenter study aimed to describe peri-intubation cardiac arrest in paediatric cardiac patients with significant (moderate or severe) systolic dysfunction of the systemic ventricle. Intubation data were collected from 4 paediatric cardiac ICUs in the United States (January 2015 - December 2017). Clinician practices during intubation of patients with significant dysfunction were compared to practices during intubation of patients without significant systolic dysfunction. There were 67 intubations in patients with significant systolic dysfunction. Peri-intubation cardiac arrest rate in this population was 14.9% (10/67); peri-intubation mortality was 3%. Majority (6/10; 60%) of the cardiac arrests were classified as pulseless electrical activity. Patients with cardiac arrest upon intubation had a higher serum lactate and lower serum pH than patients without peri-intubation cardiac arrest in the significant systolic dysfunction group.In comparing cardiac ICU patients with significant systolic dysfunction (n = 67) to patients from the same time period with normal ventricular function or mild dysfunction (n = 183), clinicians were less likely to use midazolam (11.9% versus 25.1%; p = 0.03) and more likely to use etomidate (16.4% versus 4.4%; p = 0.002) for intubation. Use of other sedative agents, video laryngoscopy, atropine, inotrope initiation, and consultation of an anaesthesiologist for intubation were not statistically different between the groups.This is the first study to describe the rate of and risk factors for peri-intubation cardiac arrest in paediatric cardiac ICU patients with systolic dysfunction. There was a higher peri-intubation cardiac arrest rate compared to published rates in critically ill children with heart disease and compared to children with significant systolic dysfunction undergoing elective general anaesthesia.
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http://dx.doi.org/10.1017/S1047951122001160DOI Listing
May 2022

Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass.

Ann Thorac Surg 2021 Oct 20. Epub 2021 Oct 20.

Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. Electronic address:

Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery-associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB).

Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay.

Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders.

Conclusions: Kidney Disease: Improving Global Outcomes-defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.
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http://dx.doi.org/10.1016/j.athoracsur.2021.09.032DOI Listing
October 2021

Challenges in Preventive Practices and Risk Communication towards COVID-19: A Cross-Sectional Study in Bangladesh.

Int J Environ Res Public Health 2021 09 2;18(17). Epub 2021 Sep 2.

Division of Public Health Science, School of Health Sciences, Mid Sweden University, 851 70 Sundsvall, Sweden.

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. A cross-sectional survey was conducted between December 2020 and January 2021 involving 1382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate handwashing and sanitation facilities (17.6%), and negative influences on family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01, 1.7), rural residents (OR = 1.5, 95% CI = 1.2, 2), respondents with a low level of education: no schooling vs. ≥higher secondary (OR = 3.5, 95% CI = 2.3, 5.2), primary vs. ≥higher secondary (OR = 2.5, 95% CI = 1.7, 3.8), respondents engaged in agricultural (OR = 1.7, 95% CI = 1.2, 2.4), laboring (OR = 3.2, 95% CI = 2, 5), and domestic works (OR = 1.6, 95% CI = 1.07, 2.5), and people with disabilities (OR = 1.7, 95% CI = 1.1, 2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents' education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. A substantial percentage of Bangladeshi adults have difficulty practising COVID-19 protective behaviours and have poor comprehension of risk communications, particularly in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.
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http://dx.doi.org/10.3390/ijerph18179259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430532PMC
September 2021

Effect of intensive blood pressure lowering on left atrial remodeling in the SPRINT.

Hypertens Res 2021 10 6;44(10):1326-1331. Epub 2021 Aug 6.

Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Upstream therapy of atrial remodeling may decrease atrial fibrillation and associated thromboembolism. We examined the impact of intensive BP lowering on ECG-defined left atrial abnormalities in the SPRINT. SPRINT was a randomized clinical trial comparing outcomes when a systolic BP of <120 mmHg (standard treatment) was the target. We included SPRINT participants without baseline atrial fibrillation who had a technically interpretable baseline ECG and at least one follow-up ECG. The primary outcome was incident left atrial abnormality, defined as P-wave terminal force in V (PTFV) > 4000 μV × ms. Secondary outcomes were regression of the left atrial abnormality and the change in PTFV from baseline across follow-up ECGs. Cox regression was used to examine the associations between treatment assignment and incident left atrial abnormality and its regression. We used linear mixed models to examine the changes in PTFV. Of 9361 SPRINT participants, 7738 qualified for this analysis, of whom 5544 did not have baseline left atrial abnormalities. Intensive BP management was not associated with incident left atrial abnormality (HR, 0.96; 95% CI, 0.87-1.07) or regression of the baseline left atrial abnormality (HR, 1.09; 95% CI, 0.98-1.21). The change in PTFV from baseline through follow-up did not differ significantly between treatment groups (difference in μV × ms per year, 6; 95% CI, -67 to 79). Thus, among patients in a randomized clinical trial, we found no difference in the progression or regression of ECG-defined left atrial abnormalities with intensive BP management compared to standard BP management.
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http://dx.doi.org/10.1038/s41440-021-00713-2DOI Listing
October 2021

Impact of community-based first responder development for the management of drowning casualties in rural areas of Bangladesh.

Afr J Emerg Med 2020 Dec 27;10(4):219-223. Epub 2020 Aug 27.

International Drowning Research Centre, Bangladesh, Mokakhali, Dhaka, Bangladesh.

Background: Drowning is the leading cause of childhood death in Bangladesh. In order to minimize the number of casualties Centre for Injury Prevention and Research, Bangladesh (CIPRB) incorporated a 'first responder' program which includes Cardio Pulmonary Resuscitation (CPR), in community based drowning prevention program, . Along with swimming lessons, swimming instructors provide first responder services in the community. The objective of this study was to describe the results of the volunteer based first responder services for the management of drowned casualties between 2012 and 2015 in the rural communities of Bangladesh.

Methods: Adolescents and youths who volunteered as community swimming instructors were trained as first responders to provide first aid and resuscitation in the community. Trainers from the International Drowning Research Centre Bangladesh (IDRC-B) of CIPRB delivered the training. The first responders were also trained on the documentation of the first responder services they provided in the community. The documented records were collected from the volunteers on a regular basis; when drowning cases were reported CIPRB management followed up with an in depth data collection, using a structured form.

Results: 2,305 community volunteers were trained between 2012 and 2015. Of them 1,461 reported providing first responder services among 6,773 casualties, including 184 drowning casualties. Of the drowning casualties, volunteers treated 31 casualties with Cardiopulmonary Resuscitation (CPR), 51 casualties by putting into the recovery position and 102 casualties were treated for the shock on site. Of those given CPR, 22 (71%) survived and 9 (29%) died. After receiving treatment from the first responder 104 (56.5%) of the drowning casualties were referred to health facilities for further treatment.

Conclusions: The training of community first responders seems to be an effective way of managing and reducing drowning causalities in countries like Bangladesh, where drowning is a significant public health hazard.
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http://dx.doi.org/10.1016/j.afjem.2020.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700990PMC
December 2020

Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial.

J Clin Med 2020 Jul 30;9(8). Epub 2020 Jul 30.

Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.

Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh.

Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility.

Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, -0.68 (-0.91, -0.45), < 0.001).

Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.
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http://dx.doi.org/10.3390/jcm9082444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464742PMC
July 2020

Concurrent diabetic ketoacidosis with hyperosmolality and/or severe hyperglycemia in youth with type 2 diabetes.

Endocrinol Diabetes Metab 2020 Jul 15;3(3):e00160. Epub 2020 Jun 15.

Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA.

Introduction: Prevalence of diabetic ketoacidosis (DKA) complicated by severe hyperglycaemia and hyperosmolality and its outcomes in youth with type 2 diabetes (T2DM) are not well-described. Our aim is to determine the frequency and clinical outcomes of isolated DKA, DKA with severe hyperglycaemia (DKA + SHG) and DKA with hyperglycaemia and hyperosmolality (DKA + HH) in youth with T2DM admitted for acute hyperglycaemic crisis.

Methods: Through retrospective medical record review, patients with T2DM were identified and categorized into isolated DKA, DKA + SHG (DKA + glucose ≥33.3 mmol/L) and DKA + HH (DKA + glucose ≥33.3 mmol/L + osmolality ≥320 mmol/kg).

Results: Forty-eight admissions in 43 patients ages 9-18 were included: 28 (58%) had isolated DKA, six (13%) had DKA + SHG and 14 (29%) had DKA + HH. Subgroups' demographics and medical history were similar. Seventeen patients (35%) had acute kidney injury (AKI). Odds of AKI were higher in DKA + SHG and DKA + HH relative to isolated DKA ( = .015 and .002 respectively). Frequency of altered mental status (AMS) was similar among groups. Three patients (6%) had concurrent soft-tissue infections at presentation with no differences among subgroup. Three patients (6%) had other medical complications. These occurred only in patients with AKI and DKA + SHG or AKI and DKA + HH.

Conclusions: In youth with T2DM, severe hyperglycaemia ± hyperosmolality frequently complicates DKA. Youth with DKA and features of hyperglycaemic hyperosmolar syndrome, including isolated severe hyperglycaemia, have increased odds of AKI.
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http://dx.doi.org/10.1002/edm2.160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7375104PMC
July 2020

Children's exposure to psychological abuse and neglect: A population-based study in rural Bangladesh.

Acta Paediatr 2021 01 20;110(1):257-264. Epub 2020 May 20.

Department of Health Sciences, Public Health Sciences, Karlstad University, Karlstad, Sweden.

Aim: We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh.

Methods: Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect.

Results: The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse.

Conclusion: The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.
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http://dx.doi.org/10.1111/apa.15340DOI Listing
January 2021

Effects of Climate Change and Maternal Morality: Perspective from Case Studies in the Rural Area of Bangladesh.

Int J Environ Res Public Health 2019 11 20;16(23). Epub 2019 Nov 20.

Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka 1206, Bangladesh.

This study explored the community perception of maternal deaths influenced by natural disaster (flood), and the practice of maternal complications during natural disaster among the rural population in Bangladesh. It also explored the challenges faced by the community for providing healthcare and referring the pregnant women experiencing complications during flood disaster. Three focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted in the marginalized rural communities in the flood-prone Khaliajhuri sub-district, Netrakona district, Bangladesh. Flood is one of the major risk factors for influencing maternal death. Pregnant women seriously suffer from maternal complications, lack of antenatal checkup, and lack of doctors during flooding. During the time of delivery, it is difficult to find a skilled attendant, and referring the patient with delivery complications to the healthcare facility. Boats are the only mode of transport. The majority of maternal deaths occur on the boats during transfer from the community to the hospital. Rural people feel that the maternal deaths influenced by natural disaster are natural phenomena. Pre-preparation is needed to support pregnant women during disasters. There is unawareness of maternal health, related care, and complications during disasters among local health service providers and volunteers.
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http://dx.doi.org/10.3390/ijerph16234594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926614PMC
November 2019

Animal-related injuries and fatalities: evidence from a large-scale population-based cross-sectional survey in rural Bangladesh.

BMJ Open 2019 11 2;9(11):e030039. Epub 2019 Nov 2.

Centre for Injury Prevention and Research, Bangladesh (CIPRB), House B162, Road 23, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.

Objective: This study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh.

Design And Setting: A cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh from June 2013 to September 2013.

Participants: A total of approximately 1.17 million individuals across all age and gender profiles were included in the survey. The participants had to be residents of the seven subdistricts and have provided consent to participate in the study.

Primary And Secondary Outcome Measures: Animal-related injury characteristics and demographic information was collected in the study. Frequency, proportion and 95% CIs of variables such as type of animal, type of animal attack, activity of the person prior to attack and the seasonality of the injury were reported. Data was then statistically analysed for associations between injury and sociodemographic characteristics.

Results: The incidence rate of fatal and non-fatal animal-related injuries across all ages were 0.7 (95% CI 0.4 to 1.4) and 1635.3 (95% CI 1612.0 to 1658.0) per 100 000 populations, respectively. Non-fatal animal-related injury rates were highest among adults 18 years and older (1820.6 per 100 000 population (1777.2 to 1865.1)), and in males across all age groups. The most common animal injury was wasp/hornet/bee sting (49%), followed by cow/buffalo (25%), dog bite (9%) and snake bites (9%).

Conclusions: Animal-related injuries are an important public health issue in rural Bangladesh. The incidence of animal-related morbidities was found high in the study area. Males, school-going and productive age groups were at high risk. Immediate attention should be given to prevent these events.
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http://dx.doi.org/10.1136/bmjopen-2019-030039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830608PMC
November 2019

Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research.

BMJ Glob Health 2019 29;4(Suppl 6):e001442. Epub 2019 Jul 29.

Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA.

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.
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http://dx.doi.org/10.1136/bmjgh-2019-001442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6666805PMC
July 2019

Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds.

Brain Sci 2019 Feb 18;9(2). Epub 2019 Feb 18.

Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA.

Despite substantial experience with deep brain stimulation for movement disorders and recent interest in electrode targeting under general anesthesia, little is known about whether awake macrostimulation during electrode targeting predicts postoperative side effects from stimulation. We hypothesized that intraoperative awake macrostimulation with the newly implanted DBS lead predicts dose-limiting side effects during device activation in clinic. We reviewed 384 electrode implants for movement disorders, characterized the presence or absence of stimulus amplitude thresholds for dose-limiting DBS side effects during surgery, and measured their predictive value for side effects during device activation in clinic with odds ratios ±95% confidence intervals. We also estimated associations between voltage thresholds for side effects within participants. Intraoperative clinical response to macrostimulation led to adjustments in DBS electrode position during surgery in 37.5% of cases (31.0% adjustment of lead depth, 18.2% new trajectory, or 11.7% both). Within and across targets and disease states, dose-limiting stimulation side effects from the final electrode position in surgery predict postoperative side effects, and side effect thresholds in clinic occur at lower stimulus amplitudes versus those encountered in surgery. In conclusion, awake clinical testing during DBS targeting impacts surgical decision-making and predicts dose-limiting side effects during subsequent device activation.
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http://dx.doi.org/10.3390/brainsci9020044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407022PMC
February 2019

Positive Airway Pressure Versus High-Flow Nasal Cannula for Prevention of Extubation Failure in Infants After Congenital Heart Surgery.

Pediatr Crit Care Med 2019 02;20(2):149-157

Division of Cardiology, Department of Pediatrics, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.

Objectives: Compare the impact of initial extubation to positive airway pressure versus high-flow nasal cannula on postoperative outcomes in neonates and infants after congenital heart surgery.

Design: Retrospective cohort study with propensity-matched analysis.

Setting: Cardiac ICU within a tertiary care children's hospital.

Patients: Patients less than 6 months old initially extubated to either high-flow nasal cannula or positive airway pressure after cardiac surgery with cardiopulmonary bypass were included (July 2012 to December 2015).

Interventions: None.

Measurements And Main Results: Of 258 encounters, propensity matching identified 49 pairings of patients extubated to high-flow nasal cannula versus positive airway pressure. Extubation failure was 12% for all screened encounters. After matching, there was no difference in extubation failure rate between groups (positive airway pressure 16% vs high-flow nasal cannula 10%; p = 0.549). However, compared with high-flow nasal cannula, patients initially extubated to positive airway pressure experienced greater resource utilization: longer time to low-flow nasal cannula (83 vs 28 hr; p = 0.006); longer time to room air (159 vs 110 hr; p = 0.013); and longer postsurgical hospital length of stay (22 vs 14 d; p = 0.015).

Conclusions: In this pediatric cohort, primary extubation to positive airway pressure was not superior to high-flow nasal cannula with respect to prevention of extubation failure after congenital heart surgery. Compared with high-flow nasal cannula, use of positive airway pressure was associated with increased hospital resource utilization. Prospective initiatives aimed at establishing best clinical practice for postoperative noninvasive respiratory support are needed.
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http://dx.doi.org/10.1097/PCC.0000000000001783DOI Listing
February 2019

Associations of Mood on Objective and Subjective Cognitive Complaints in Persons Living with HIV/AIDS.

J HIV AIDS 2018 9;4(1). Epub 2018 Jan 9.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA.

Healthcare workers commonly rely on patient self-report to identify problems with cognitive functioning among Persons Living with HIV (PLWH). Self-reported cognitive complaints may not accurately reflect objective cognitive performance and may be obscured by co-occurring depression. The purpose of the current study was to examine the relationships among depression, subjective cognitive complaints, and objective cognitive performance in PLWH using measures easily administered by healthcare workers. Particularly, this study assessed the association between subjective cognitive complaints (MOS-HIV) and objective cognitive performance (mHDS) using a simple screening tool, as well as whether depressive symptoms (CES-D 10) moderated this relationship. This was a secondary data analysis of a parent study that enrolled participants (N=207) from outpatient HIV clinics in Florida between 2009 and 2011. Most participants identified themselves as African American (82.6%) and heterosexual (81.6%). Almost half of the participants were male (46.4%). Fifty-one percent of participants had a score of 10 or greater on CES-D, indicating clinical depression. This study found no association between subjective and objective cognitive measures; depressive symptoms exhibited no moderating effect on the relationship between subjective cognitive complaints and objective cognitive performance. Depressive symptoms were significantly associated with subjective perceptions of cognitive ability. Results suggest that subjective cognitive complaints may be an inadequate tool for identifying objective cognitive impairments among PLWH. Additionally, treatment of depressive symptoms may help alleviate subjective cognitive complaints.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935453PMC
http://dx.doi.org/10.16966/2380-5536.146DOI Listing
January 2018

A latent class analysis of PTSD symptoms among inner city primary care patients.

J Psychiatr Res 2018 03 7;98:1-8. Epub 2017 Dec 7.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA. Electronic address:

Objectives: Examine evidence for different subclasses of posttraumatic stress disorder (PTSD) symptoms in a sample of trauma exposed, low-income, predominantly African American men and women. Assess the relationship between PTSD subclasses with major depressive disorder (MDD) and types of trauma experienced.

Method: Latent class analysis (LCA) using a multivariate normal mixture model on the 17-item PTSD Symptom Scale (PSS) was used to identify latent subclasses of PTSD symptoms (N = 5063).

Results: LCA suggested four subclasses of PTSD symptoms: (1) High severity and comorbidity (n = 932, 92.2% current PTSD, 88.7% MDD, 82% both), characterized by high PTSD symptoms, depression, and comorbidity of PTSD and MDD; (2) Moderate severity (n = 1179, 56.5% current PTSD, 53.9% MDD, 34.5% both), which had high avoidance and hyper-vigilance symptoms compared to the other symptoms; (3) Low PTSD and high depression (n = 657, 12.8% current PTSD, 49.9% MDD, 8.8% both) which had high insomnia but otherwise low PTSD symptoms and high depression; and (4) Resilient (n = 2295, 2.0% current PTSD, 16.4% MDD, and 0.6% both) characterized by low mean scores on all PTSD symptoms and depression.

Conclusions: The results suggest avoidance and hyper-vigilance are important symptoms in PTSD development and insomnia may be an important indicator for depression. The combination of severe insomnia, avoidance, and hyper-vigilance may be key symptoms for comorbidity of PTSD and MDD. Future studies should focus on these symptoms to better target people at high risk for developing PTSD or MDD.
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http://dx.doi.org/10.1016/j.jpsychires.2017.11.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801065PMC
March 2018

Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh.

Lancet Glob Health 2017 08;5(8):e818-e827

Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: 90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study.

Methods: In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes.

Findings: The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries.

Interpretation: The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1-4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh.

Funding: Bloomberg Philanthropies.
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http://dx.doi.org/10.1016/S2214-109X(17)30244-9DOI Listing
August 2017

Nonparametric Regression Method for Broad Sense Agreement.

J Nonparametr Stat 2017 17;29(2):280-300. Epub 2017 Mar 17.

Department of Biostatistics and Bioinformatics, Emory University Atlanta, GA 30322, U.S.A.

Characterizing the correspondence between an ordinal measurement and a continuous measurement is often of interest in mental health studies. To this end, Peng, Li, Guo, and Manatunga (2011) introduced the concept of broad sense agreement (BSA) and developed nonparametric estimation and inference for a BSA measure. In this work, we propose a non-parametric regression framework for BSA, which provides a robust tool to further investigate population heterogeneity in BSA. We develop inferential procedures including regression function estimation and hypothesis testing. Extensive simulation studies demonstrate satisfactory performance of the proposed method. We also apply the new method to a recent Grady Trauma Study and reveal an interesting impact of depression severity on the alignment between a self-reported symptom instrument and clinician diagnosis in posttraumatic stress disorder (PSTD) patients.
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http://dx.doi.org/10.1080/10485252.2017.1303058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440120PMC
March 2017

A general approach to categorizing a continuous scale according to an ordinal outcome.

J Stat Plan Inference 2016 May;172:23-25

Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road NE., Atlanta, GA 30322, USA.

In practice, disease outcomes are often measured in a continuous scale, and classification of subjects into meaningful disease categories is of substantive interest. To address this problem, we propose a general analytic framework for determining cut-points of the continuous scale. We develop a unified approach to assessing optimal cut-points based on various criteria, including common agreement and association measures. We study the nonparametric estimation of optimal cut-points. Our investigation reveals that the proposed estimator, though it has been ad-hocly used in practice, pertains to nonstandard asymptotic theory and warrants modifications to traditional inferential procedures. The techniques developed in this work are generally adaptable to study other estimators that are maximizers of nonsmooth objective functions while not belonging to the paradigm of M-estimation. We conduct extensive simulations to evaluate the proposed method and confirm the derived theoretical results. The new method is illustrated by an application to a mental health study.
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http://dx.doi.org/10.1016/j.jspi.2015.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770918PMC
May 2016

The burden of road traffic injuries in South Asia: a commentary.

J Coll Physicians Surg Pak 2004 Dec;14(12):707-8

Department of Epidemiology and Biostatistics, Institute of Child and Mother Health, Dhaka, Bangladesh.

Around 238,000 people die in road crashes every year in South Asian countries. However, no information on road traffic injuries in South Asian countries is available to estimate the magnitude of the problem in terms of the various levels of severity. It has been estimated that for one RTI death, there are 20 hospitalizations, 50 emergency room visits, and more than 100 minor injuries. Together with the social impact in terms of pain, grief and suffering, RTIs impose a very large economic burden on the countries affected. Considering a gross estimate of 1% of GDP as economic loss from RTIs in South Asian countries runs into US$ 25 billion a year which is more than 50% the total annual amount of development assistance worldwide. The main reasons for high burden of road traffic injuries in this region are growth in the number of motor vehicles, poor enforcement of traffic safety regulations, poor quality of roads and vehicles, and inadequate public health infrastructures.
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http://dx.doi.org/12.2004/JCPSP.707708DOI Listing
December 2004
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