Conectar
In Tanzania, acute myocardial infarction (AMI) is underdiagnosed, and uptake of evidence-based care is suboptimal. Using an implementation science approach, an intervention was developed to address local barriers to care: the Multicomponent Intervention for Improving Myocardial Infarction Care in Tanzania (MIMIC).
This sequential cohort design trial was conducted in a single northern Tanzanian emergency department (ED). During the preintervention phase (February–August 2023) and the postintervention phase (September 2023–August 2024), adults presenting with chest pain and/or dyspnoea were prospectively enrolled and their ED care was observed. AMI was defined by the Fourth Universal Definition criteria. Telephone follow-ups were conducted to ascertain 30-day mortality. Pearson’s ² was used to compare care before and after MIMIC implementation.
A total of 275 participants were enrolled in the preintervention phase and 577 were enrolled in the postintervention phase. Following MIMIC implementation, significant increases were observed in ECG testing (89.4% of postintervention participants vs 55.3% preintervention, OR 6.82, 95% CI 4.79 to 9.79, p
The MIMIC intervention was associated with large increases in uptake of AMI testing, case identification and evidence-based treatment in a single Tanzanian ED. Multisite studies are needed to evaluate the effect of MIMIC on AMI care in diverse settings across Tanzania.
by Samantha Hertz, Finnegan Klein, Todd L. Bredbenner, Miranda Cosman, Karl J. Jepsen
Developing a strong skeleton during growth is critical for minimizing fractures later in life. Prior work showed that bone mass varied with external bone size, a measure of the outer bone width. We tested how this association affected the identification of children with low bone mass. Radiographs of the nondominant hand of 45 White females and 54 White males, all ~ 8 years old, were assessed and second metacarpal length (Le) and the midshaft outer and inner widths were measured at the 40, 50, and 60% midshaft sites. The average total area (Tt.Ar), a measure of the area enclosed by the periosteal surface, and cortical area (Ct.Ar), a measure of bone mass, were calculated assuming a circular cross-section. Individuals were sorted into tertiles using robustness (Tt.Ar/Le). Z-scores were calculated for Ct.Ar first using the cohort mean and standard deviation and second using each robustness tertile mean and standard deviation. Females and males with Z-scores in the lower 33% range were identified for the group-average and tertile-specific average comparisons. Agreement between the two reference group approaches was determined using Cohen’s kappa statistic for each sex. The percentage of individuals identified with low Ct.Ar depended on whether Z-scores were compared to the group average or tertile-specific averages. When compared to the group average, 67% of females and 56% of males identified with lower Ct.Ar were from the narrowest tertile, whereas 0% of females and 22% of males were from the widest tertile. For females and males, Cohen’s kappa coefficient showed almost perfect agreement for the intermediate tertile (kappa coefficient > 0.84), but agreement was only poor to moderate (kappa coefficient
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