Category: Nevin Manimala

Neuropsychology. 2024 Nov 18. doi: 10.1037/neu0000983. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate associations of executive function (EF) performance in adolescence with dimensional symptoms of inattention and hyperactivity-impulsivity assessed by multiple informants as well as ADHD (attention-deficit/hyperactivity disorder) symptoms based on the Diagnostic and Statistical Manual of Mental Disorders criteria, and whether familial factors and co-occurring symptoms of depressive disorder and conduct disorder explain these associations in a population-based sample.

METHOD: In 14-year-old twins from the population-based FinnTwin12 study (N = 638-1,227), we assessed EF with commonly used neuropsychological tests. Diagnostic and Statistical Manual of Mental Disorders symptoms of ADHD and psychiatric disorders were assessed with a semistructured interview, and dimensional symptoms of inattention and hyperactivity-impulsivity with behavioral ratings made by the twins, their co-twins, and teachers at age 14, and by parents and teachers at age 12, the latter being different from those at age 14.

RESULTS: Teacher-rated inattention had the strongest association with poorer EF performance across two measurement points with different teachers; these associations were not affected by adding symptoms of depressive disorder and conduct disorder as covariates. Within-pair analyses suggested that the associations of inattention and hyperactivity-impulsivity with EF were partly explained by familial factors.

CONCLUSION: Even at a subclinical level in a sample of adolescents representing general population, ADHD symptoms are associated with EF performance. Teachers’ evaluations appear especially valuable when assessing adolescents’ ADHD symptoms. Our findings support the notion of dimensional ADHD symptoms in the population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556384 | DOI:10.1037/neu0000983

Cancer Control. 2024 Jan-Dec;31:10732748241302427. doi: 10.1177/10732748241302427.

ABSTRACT

Effective cancer screening is essential for early detection and improved survival outcomes. Cancer is a leading cause of death for Hispanics/Latinx, who represent the largest minority group in the U.S. Despite lower tobacco use, lung cancer is the leading cause of cancer death in Hispanic/Latinx men and the second leading cause in women. Late-stage diagnoses, due to limited screening opportunities, contribute to poor survival rates. Cancer survivors, especially those previously diagnosed with head and neck cancer, face a significantly increased risk of developing lung cancer. Approximately one-fourth of head and neck cancer survivors die from a second malignancy, with lung cancer accounting for over half of these cases. These individuals are nearly three times more likely to develop lung cancer compared to the general population of smokers. In this manuscript, we detail the importance of implementing lung cancer screening in these high-risk populations.

PMID:39556362 | DOI:10.1177/10732748241302427

Personal Disord. 2024 Nov 18. doi: 10.1037/per0000707. Online ahead of print.

ABSTRACT

Disinhibition is a personality trait with broad health implications and has been included in several prominent models of maladaptive personality traits and psychopathology, such as the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Alternative Model of Personality Disorders and the Hierarchical Taxonomy of Psychopathology. Cross-sectional global self-report and clinical interview research suggests that disinhibition is tightly linked with interpersonal problems, particularly antagonistic problems. However, very little work has examined how individual differences in disinhibition manifest in interpersonal functioning in social situations in daily life. We examined how trait disinhibition and its lower level facets (e.g., irresponsibility, impulsivity, distractibility) relate to ecological momentary assessments of interpersonal interactions in daily life across three samples (total person N = 1,068, total observation N = 38,212). Results showed a consistent and positive association between trait disinhibition and negative affect in daily life (both in general and specifically during social interactions), above and beyond the effect of trait antagonism. We also found a negative association between trait disinhibition and warmth during social interactions, though this effect was fully accounted for by trait antagonism. We did not find consistent associations between trait disinhibition and positive affect or dominance in daily life. These findings have implications for the manifestation of disinhibition in daily life and the relation between externalizing and internalizing psychopathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556354 | DOI:10.1037/per0000707

JAMA Intern Med. 2024 Nov 18. doi: 10.1001/jamainternmed.2024.5981. Online ahead of print.

ABSTRACT

IMPORTANCE: Hyponatremia treatment guidelines recommend limiting the correction of severe hyponatremia during the first 24 hours to prevent osmotic demyelination syndrome (ODS). Recent evidence suggests that slower rates of correction are associated with increased mortality.

OBJECTIVE: To evaluate the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

DATA SOURCES: We searched MEDLINE, Embase, the Cochrane Library, LILACS, Web of Science, CINAHL, and international congress proceedings for studies published between January 2013 and October 2023.

STUDY SELECTION: Comparative studies assessing rapid (≥8-10 mEq/L per 24 hours) vs slow (<8 or 6-10 mEq/L per 24 hours) and very slow (<4-6 mEq/L per 24 hours) correction of severe hyponatremia (serum sodium <120 mEq/L or <125 mEq/L plus severe symptoms) in hospitalized patients.

DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers (N.A.F., J.R.M., J.M.A., A.C.) independently reviewed studies, extracted data, and assessed each included study’s risk of bias using ROBINS-I. Cochrane methods, PRISMA reporting guidelines, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate the certainty of evidence were followed. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES: Primary outcomes were in-hospital and 30-day mortality, and secondary outcomes were hospital length of stay (LOS) and ODS.

RESULTS: Sixteen cohort studies involving a total of 11 811 patients with severe hyponatremia were included (mean [SD] age, 68.22 [6.88] years; 56.7% female across 15 studies reporting sex). Moderate-certainty evidence showed that rapid correction was associated with 32 (odds ratio, 0.67; 95% CI, 0.55-0.82) and 221 (odds ratio, 0.29; 95% CI, 0.11-0.79) fewer in-hospital deaths per 1000 treated patients compared with slow and very slow correction, respectively. Low-certainty evidence suggested that rapid correction was associated with 61 (risk ratio, 0.55; 95% CI, 0.45-0.67) and 134 (risk ratio, 0.35; 95% CI, 0.28-0.44) fewer deaths per 1000 treated patients at 30 days and with a reduction in LOS of 1.20 (95% CI, 0.51-1.89) and 3.09 (95% CI, 1.21-4.94) days, compared with slow and very slow correction, respectively. Rapid correction was not associated with a statistically significant increased risk of ODS.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, slow correction and very slow correction of severe hyponatremia were associated with an increased risk of mortality and hospital LOS compared to rapid correction.

PMID:39556338 | DOI:10.1001/jamainternmed.2024.5981

Epilepsia. 2024 Nov;65(11):3324-3334. doi: 10.1111/epi.18118. Epub 2024 Sep 18.

ABSTRACT

OBJECTIVE: Phenotypic heterogeneity presents challenges in providing clinical care to patients with pathogenic SCN8A variants, which underly a wide disease spectrum ranging from neurodevelopmental delays without seizures to a continuum of mild to severe developmental and epileptic encephalopathies (DEEs). An important unanswered question is whether there are clinically important subgroups within this wide spectrum. Using both supervised and unsupervised machine learning (ML) approaches, we previously found statistical support for two and three subgroups associated with loss- and gain- of- function vari-ants, respectively. Here, we test the hypothesis that the unsupervised subgroups (U1-U3) are distinguished by differential contributions of developmental and epileptic components.

METHODS: We predicted that patients in the U1 and U2 subgroups would differ in timing of developmental delay and seizure onset, with earlier and concurrent onset of both features for the U3 subgroup. Standard statistical procedures were used to test these predictions, as well as to investigate clinically relevant associations among all five subgroups.

RESULTS: Two-population proportion and Kruskal-Wallis tests supported the hypothesis of a reversed order of developmental delay and seizure onset for patients in U1 and U2, and nearly synchronous developmental delay/seizure onset for the U3 (termed DEE) subgroup. Association testing identified subgroup variation in treatment response, frequency of initial seizure type, and comorbidities, as well as different median ages of developmental delay onset for all five subgroups.

SIGNIFICANCE: Unsupervised ML approaches discern differential developmental and epileptic components among patients with SCN8A-related epilepsy. Patients in U1 (termed developmental encephalopathy) typically gain seizure control yet rarely experience improvements in development, whereas those in U2 (termed epileptic encephalopathy) have fewer if any developmental impairments despite difficulty in achieving seizure control. This understanding improves prognosis and clinical management and provides a framework to discover mechanisms underlying variability in clinical outcome of patients with SCN8A-related disorders.

PMID:39556335 | DOI:10.1111/epi.18118

Egypt Heart J. 2024 Nov 18;76(1):151. doi: 10.1186/s43044-024-00578-z.

ABSTRACT

BACKGROUND: Myocardial deformation by speckle tracking echocardiography provides valuable information on the left ventricular function. The study aims to assess myocardial deformation in terms of left ventricular strain as an indicator of myocardial function in children after cardiac surgery at outpatient follow-up visits.

METHODS: The study design was a prospective observational cross-sectional study that included pediatric patients after biventricular cardiac surgery during the postoperative follow-up visits in the outpatient department. In addition to conventional echocardiographic examination, two-dimensional speckle tracking echocardiography was done to evaluate myocardial deformation in terms of left ventricular strain. Echocardiographic measurements were done offline and were compared to published reference normal values for age. Study subjects were divided according to age at follow-up into four groups (1 month-1 year, 1-2 years, 2-5 years, and 5-11 years).

RESULTS: Over ten months, 100 patients (64 males and 36 females) were included in the study. The median age was 30.8 months (IQR 12.8-65.3 months), the median weight was 11.7 kg (IQR 8-17 kg) and the median duration after surgery was 7.3 months (IQR 3.2-30.8 months). Longitudinal strain values were significantly (p < 0.001) lower than reference values for different age groups. Global circumferential strain showed no significant difference from the reference values. The duration after surgery had a statistically significant effect on longitudinal strain values, with improvement of the strain values with increasing intervals after surgery.

CONCLUSION: Using myocardial deformation method to evaluate cardiac function may detect underlying cardiac function abnormalities even with normal traditional functional parameters, which could have implications for patient management and follow-up.

PMID:39556306 | DOI:10.1186/s43044-024-00578-z

Adv Ther. 2024 Nov 18. doi: 10.1007/s12325-024-03053-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Although clinical, functional, and biomarker data predict asthma exacerbations, newer approaches providing high accuracy of prognosis are needed for real-world decision-making in asthma. Machine learning (ML) leverages mathematical and statistical methods to detect patterns for future disease events across large datasets from electronic health records (EHR). This study conducted training and fine-tuning of ML algorithms for the real-world prediction of asthma exacerbations in patients with physician-diagnosed asthma.

METHODS: Adults with ≥ 2 ICD9/10 asthma codes within 1 year and at least 30 days apart were identified from the Optum Panther EHR database between 2016 and 2023. An emergency department (ED), urgent care, or inpatient visit for asthma, while on systemic administration of corticosteroids, was considered an exacerbation. To predict factors associated with exacerbations in a 6-month study period, clinical information from patients was retrieved in the preceding 6-month baseline period. Clinical information included demographics, lab results, diagnoses, medications, immunizations, and allergies. Three models built using Extreme Gradient Boosting (XGBoost), Long Short-Term Memory (LSTM), and Transformers algorithms were trained and tested on independent datasets. Predictions were explained using the SHAP (SHapley Additive exPlanations) library.

RESULTS: Of 1,331,934 patients with asthma, 16,279 (1.2%) experienced ≥ 1 exacerbation. XGBoost was the best predictive algorithm (area under the curve [AUC] = 0.964). Factors associated with exacerbations included a prior history of exacerbation, prednisone usage, high-dose albuterol usage, and elevated troponin I. Reduced probability of exacerbations was associated with receiving inhaled albuterol, vitamins, aspirin, statins, furosemide, and influenza vaccination.

CONCLUSION: This ML-based study on asthma in the real world confirmed previously known features associated with increased exacerbation risk for asthma, while uncovering not entirely understood features associated with reduced risk of asthma exacerbations. These findings are hypothesis-generating and should contribute to ongoing discussion of the strengths and limitations of ML and other supervised learning models in patient risk stratification.

PMID:39556295 | DOI:10.1007/s12325-024-03053-y

Health Econ Rev. 2024 Nov 18;14(1):94. doi: 10.1186/s13561-024-00573-9.

ABSTRACT

OBJECTIVES: Value-based insurance design (VBID) aims to direct consumers’ preferences by incentivizing the use of high-value care and discouraging the use of low-value care. However, consumers often have limited knowledge of health insurance and the health insurance system, possibly distorting their preferences. In this study, we aim to investigate the impact of specific information treatments on consumers’ preferences for VBID.

METHODS: We implemented an information experiment as part of a representative survey on health insurance literacy and preferences for VBID within Switzerland’s choice-based health insurance system. Preferences for VBID were measured through a discrete choice experiment. Cross-sectional data on 6,033 respondents aged 26-75 were analyzed using descriptive statistics and mixed logit regressions.

RESULTS: Respondents showed strong preferences for their current health insurance instead of VBID alternatives. A general description of current regulations on cost-sharing, drug disbursement, and monthly premiums significantly increased preferences for VBID (p < 0.01). Pointing respondents specifically to VBID further reduced the opposition against VBID plans. At the same time, there is evidence for anchoring effects in copayments after receiving the information treatments, irrespective of the value of the care.

CONCLUSIONS: The results of this study highlight that individuals are susceptible to provided information about health insurance when building their preferences for VBID. One potential explanation is limited health insurance literacy, implying that tailored communication strategies may be needed to improve insurance decision-making.

JEL CLASSIFICATION: I11, I13.

PMID:39556285 | DOI:10.1186/s13561-024-00573-9

Hernia. 2024 Nov 18;29(1):22. doi: 10.1007/s10029-024-03219-1.

ABSTRACT

PURPOSE: To evaluate the effectiveness of prophylactic mesh placement in reducing the incidence of parastomal hernias following colostomy, ileostomy, and ileal conduit formation.

METHODS: A systematic review identified relevant studies evaluating parastomal hernia incidence with prophylactic mesh use during stoma formation. Pairwise meta-analysis and network meta-analysis using Bayesian modeling were performed.

RESULTS: 25 studies, consisting of 16 randomized control trials (RCT), 6 follow up studies, and 3 retrospective cohort studies, were included. Prophylactic mesh led to significantly fewer parastomal hernias beyond 6 months follow-up (OR 0.43, 95% CI 0.33-0.58). Hernias were reduced with mesh for both ileal conduits and colostomies. When analyzing hazard ratios (HRs), only 6 studies were included, and a statistically significant difference was observed among both randomized controlled trials (RCTs) (HR 0.75 [0.53, 0.92], p = 0.01) and non-RCTs (HR 0.57 [0.36, 0.92], p = 0.02). Network meta-analysis found the retromuscular approach with mesh had the lowest hernia rate. Regression was non-significant for variations between study types.

CONCLUSION: This meta-analysis demonstrated prophylactic mesh placement during ostomy creation significantly reduced parastomal hernia risk, more prominently beyond 6 months, consistently across randomized trials and observational studies for urologic and gastrointestinal ostomies. The retromuscular technique was most effective.

PMID:39556272 | DOI:10.1007/s10029-024-03219-1

Clin Child Fam Psychol Rev. 2024 Nov 18. doi: 10.1007/s10567-024-00497-0. Online ahead of print.

ABSTRACT

As attachment-based interventions can improve caregiver-infant relationships and their subsequent psychological outcomes, the identification of relevant and effective interventions can facilitate their implementation into clinical practice. This systematic review aimed to a) provide an overview of manualised attachment-based interventions, without video-feedback as the main component, for caregivers and infants from conception to two years, and b) determine which of these interventions were effective in demonstrating improvements in caregiver-infant relational outcomes. To identify eligible interventions and their empirical evidence base, two search stages were conducted for 1) relevant interventions and 2) studies of interventions identified in the first stage that focussed on caregiver-infant relational outcomes. All studies included in Stage 2 were quality assessed and findings analysed. Twenty-six interventions were eligible for inclusion at Stage 1 but studies reporting on relational outcomes were identified for 16 interventions only. Forty studies reporting on those 16 interventions met inclusion criteria and were synthesised at Stage 2. Most studies were of good quality. Observer-rated measures were used in 90% of studies. There was evidence for these interventions in relation to improving caregiver-infant relational outcomes: 80% of studies reported a statistically significant positive change in a relational outcome for the intervention compared to pre-intervention or control group. The most promising evidence was identified for Attachment and Biobehavioral Catch-Up (ABC), Minding the Baby (MTB) and Circle of Security (COS). This systematic review offers guidance to healthcare professionals, commissioners and policymakers within perinatal sectors in relation to the training, delivery and implementation of evidenced manualised attachment-based interventions.

PMID:39556257 | DOI:10.1007/s10567-024-00497-0