Category: Nevin Manimala

PLoS One. 2024 Dec 27;19(12):e0316261. doi: 10.1371/journal.pone.0316261. eCollection 2024.

ABSTRACT

INTRODUCTION: Lung cancer, one of the leading causes of death due to neoplasms, requires prompt diagnosis and immediate treatment. The COVID-19 pandemic affected healthcare systems worldwide, having adverse effects on all aspects, particularly on the fate of patients with suspected neoplastic diseases. Limited access to healthcare, disruptions in regular operations (reassigning roles to some wards), postponed hospital admissions, prolonged diagnostic processes, and other factors have collectively led to the phenomenon known as COVID-19 debt.

MATERIAL AND METHODS: A retrospective analysis covered statistical data concerning the diagnosis of lung cancer obtained from three centres in northern Poland (Olsztyn, Bydgoszcz, Gdansk) and concerning years 2016 to 2022. Relative risks (RR) with 95% confidence intervals (CI) for cancer event were calculated. Before the pandemic, these centers prioritized the diagnosis of suspected lung cancer cases, which was subsequently disrupted during the pandemic due to various factors.

RESULTS: The COVID-19 pandemic led to a decrease in diagnosed lung cancer cases, especially in hospitals repurposed for COVID-19 care. A statistically significant trend in lung cancer incidence per 100,000 inhabitants was observed specifically in healthcare centers that maintained normal operations without disruption.

CONCLUSION: The concept of the COVID debt helps explain changes in lung cancer diagnosis during and post-pandemic, highlighting the need for increased public awareness and intensified diagnostic efforts to facilitate earlier disease detection.

PMID:39729487 | DOI:10.1371/journal.pone.0316261

Schizophr Bull. 2024 Dec 27:sbae176. doi: 10.1093/schbul/sbae176. Online ahead of print.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Respective abnormal structural connectivity (SC) and functional connectivity (FC) have been reported in individuals with schizophrenia. However, transmodal associations between SC and FC following antipsychotic treatment, especially in female schizophrenia, remain unclear. We hypothesized that increased SC-FC coupling may be found in female schizophrenia, and could be normalized after antipsychotic treatment.

STUDY DESIGN: Sixty-four female drug-naïve patients with first-diagnosed schizophrenia treated with antipsychotic drugs for 8 weeks, and 55 female healthy controls (HCs) were enrolled. Magnetic resonance imaging (MRI) data were collected from HCs at baseline and from patients at baseline and after treatment. SC and FC were analyzed by network-based statistics, calculating nonzero SC-FC coupling of the whole brain and altered connectivity following treatment. Finally, an Elastic-net logistic regression analysis was employed to establish a predictive model for evaluating the clinical efficacy treatment.

STUDY RESULTS: At baseline, female schizophrenia patients exhibited abnormal SC in cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, and limbic-cerebellar connectivity compared to HCs, while FC showed no abnormalities. Following treatment, cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, temporal-cerebellar, and limbic-cerebellar connectivity were altered in both SC and FC. Additionally, SC-FC coupling of altered connectivity was higher in patients at baseline than in HC, trending toward normalization after treatment. Furthermore, identified FC or/and SC predicted changes in psychopathological symptoms and cognitive impairment among female schizophrenia following treatment.

CONCLUSIONS: SC-FC coupling may be a potential predictive biomarker of treatment response. Cortico-cortical, frontal-limbic, frontal-striatal, limbic-striatal, temporal-cerebellar, and limbic-cerebellar could represent major targets for antipsychotic drugs in female schizophrenia.

PMID:39729483 | DOI:10.1093/schbul/sbae176

Int J Methods Psychiatr Res. 2025 Mar;34(1):e70011. doi: 10.1002/mpr.70011.

ABSTRACT

OBJECTIVES: Heterogeneity of treatment effect (HTE) is a concern in substance use disorder (SUD) treatments but has not been rigorously examined. This exploratory study applied a causal forest approach to examine HTE in psychosocial SUD treatments, considering multiple covariates simultaneously.

METHODS: Data from 12 randomized controlled trials of nine psychosocial treatments were obtained from the National Institute on Drug Abuse Clinical Trials Network. Using causal forests, we estimated the conditional average treatment effect (CATE) on drug abstinence. To assess HTE, we compared CATE variance against total outcome variability, conducted an omnibus test, and applied the Rank-Weighted Average Treatment Effect (RATE).

RESULTS: Across nine interventions, CATE variance was lower than total outcome variability, indicating lack of strong evidence of HTE with respect to the baseline covariates considered. The omnibus test and RATE analysis generally support this finding. However, the RATE analysis identified potential HTE in a motivational interviewing trial; this could be a false positive given the multiple analyses; replication is needed to confirm this.

CONCLUSIONS: While causal forests show utility in exploring HTE in SUD interventions, limited baseline assessments in most trials suggest a cautious interpretation. The RATE findings for motivational interviewing highlight potential subgroup-specific treatment benefits, warranting further research.

PMID:39729473 | DOI:10.1002/mpr.70011

PLoS One. 2024 Dec 27;19(12):e0312749. doi: 10.1371/journal.pone.0312749. eCollection 2024.

ABSTRACT

Multitasking (MT)-performing more than one task at a time-has become ubiquitous in everyday life. Understanding of how MT is learned could enable optimizing learning regimes for tasks and occupations that necessitate frequent MT. Previous research has distinguished between MT learning regimes in which all tasks are learned in parallel, single-task (ST) learning regimes in which all tasks are learned individually, and mixed learning regimes (Mix) in which MT and ST regimes are mixed. Research using simple laboratory tasks has consistently shown that MT regimes are the most efficient-the so-called dual-task practice advantage. However, it is currently unclear which learning regimes are used in everyday life, and which regime people would prefer if given a choice. To answer these questions, 72 participants completed an online survey to describe their real-life experiences of MT learning (e.g., when learning to drive), their opinions about learning MT activities, and filled out the Multitasking Preference Inventory to assess polychronicity. Descriptive statistics showed that for everyday activities, particularly learning to drive, Mix regimes were both the most used and most preferred method, whereas MT regimes were the least preferred. A potential explanation is that everyday MT tasks are typically complex, and so people prefer to learn the individual tasks first, before combining the tasks into an MT learning regime. Preference to engage in MT, as assessed by the MPI, positively correlated (Pearson’s r = .24) with preference for MT learning regimes, suggesting that individual differences in learning of complex everyday MT activities can be determined. In conclusion, everyday life multitasking activities such as learning to drive are mostly learned in Mix regimes, i.e. a combination of ST and MT training, and people’s preference to learn such activities with MT regimes increases with their level of polychronicity.

PMID:39729471 | DOI:10.1371/journal.pone.0312749

PLoS One. 2024 Dec 27;19(12):e0316163. doi: 10.1371/journal.pone.0316163. eCollection 2024.

ABSTRACT

BACKGROUND: Home-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient’s motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization.

METHODS: We retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1-2 sessions of 40-60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared.

RESULTS: The participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p < 0.001), Standing test for Imbalance and Disequilibrium test (p = 0.025), Functional Independence Measure (p < 0.001), modified Frenchay Activities Index (p < 0.001). Additionally, a statistically significant improvement was observed in the Japanese Zarit Caregiver Burden Interview score at 6 months from baseline (p < 0.001).

CONCLUSIONS: Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.

PMID:39729469 | DOI:10.1371/journal.pone.0316163

JAMA Netw Open. 2024 Dec 2;7(12):e2451341. doi: 10.1001/jamanetworkopen.2024.51341.

ABSTRACT

IMPORTANCE: Patients with juvenile idiopathic arthritis (JIA) may develop adult rheumatic diseases later in life, and prolonged or recurrent disease activity is often associated with substantial disability; therefore, it is important to identify patients with JIA at high risk of developing adult rheumatic diseases and provide specialized attention and preventive care to them.

OBJECTIVE: To elucidate the full extent of the genetic association of JIA with adult rheumatic diseases, to improve treatment strategies and patient outcomes for patients at high risk of developing long-term rheumatic diseases.

DESIGN, SETTING, AND PARTICIPANTS: In this genetic association study of 4 disease genome-wide association study (GWAS) cohorts from 2013 to 2024 (JIA, rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], and systemic sclerosis [SSc]), patients in the JIA cohort were recruited from the US, Australia, and Norway (with a UK cohort included in the meta-analyzed cohort), while patients in the other 3 cohorts were recruited from US and Western European countries. All analyses were conducted between September 2023 and April 2024.

EXPOSURES: Genetic associations.

MAIN OUTCOMES AND MEASURES: Genetic correlations and shared genomic loci between JIA and adult rheumatic diseases. Genetic correlation analyses and cross-trait meta-analysis were conducted on the JIA cohort and the summary statistics of the GWASs from adult rheumatic diseases (RA, SLE, and SSc). Mendelian randomization analyses were also conducted.

RESULTS: This study included 33 207 patients across the 4 cohorts, with 4550 patients in the meta-analyzed JIA cohort (JIA cohort: 1485 patients with arthritis onset before 16 years; 1017 female [68.5%]; 10 352 controls; UK cohort: 3305 patients with JIA; 9196 controls), 143 61 patients in the RA cohort, 5201 patients in the SLE cohort; and 9095 patients in the SSc cohort. After the GWAS result of the JIA cohort was meta-analyzed with the UK JIA cohort, there was a total of 4550 JIA cases and 18 446 controls. The analysis revealed a significant global correlation between JIA and adult rheumatic diseases, with 84 regions harboring signals associated with multiple diseases. Cross-trait analyses uncovered novel disease loci and 20 loci associated with JIA and adult diseases. Mendelian randomization analysis revealed the significant association of 11 proteins with rheumatic disorders. Both shared, organ-specific, and disease-specific critical cell types were highlighted.

CONCLUSIONS AND RELEVANCE: In this genetic association study, there was significant genetic overlap between JIA and adult rheumatic diseases. These findings may help to refine JIA classification, risk stratification, and therapeutic strategy of repurposing adult disease drugs for pediatric patients with similar mechanisms.

PMID:39729320 | DOI:10.1001/jamanetworkopen.2024.51341

JAMA Netw Open. 2024 Dec 2;7(12):e2452652. doi: 10.1001/jamanetworkopen.2024.52652.

ABSTRACT

IMPORTANCE: A growing body of literature suggests the presence of a prodromal period with nonspecific signs and symptoms before onset of multiple sclerosis (MS).

OBJECTIVE: To systematically assess diseases and symptoms diagnosed in the 5 years before a first MS- or central nervous system (CNS) demyelinating disease-related diagnostic code in pediatric patients compared with controls without MS and controls with another immune-mediated disorder, juvenile idiopathic arthritis (JIA).

DESIGN, SETTING, AND PARTICIPANTS: This population-based, matched case-control study included children and adolescents (aged <18 years) in Germany with statutory health insurance from January 2010 to December 2020. The study population consisted of 3 groups: case individuals with MS, control individuals without MS, and control individuals with JIA. Data were analyzed from November 2023 to April 2024.

EXPOSURES: Diagnoses coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM).

MAIN OUTCOME AND MEASURES: The main outcome was incident cases of MS, defined as the first confirmed diagnosis of MS (ICD-10-GM code G35) in 1 quarter between 2013 and 2020 and at least 1 additional diagnosis in the following quarters. In total, 163 ICD-10-GM codes before a first MS diagnosis were assessed using univariable and multivariable logistic regression analyses.

RESULTS: The study population consisted of 1091 children and adolescents with MS, 10 910 without MS, and 1068 with JIA. Of the children and adolescents with MS, 788 (72.2%) were female. Mean (SD) age at disease diagnosis was 15.7 (1.7) years. Nine ICD-10-GM codes were present more frequently among children and adolescents with MS in the 5 years before their first MS diagnosis than among controls without MS: obesity (adjusted odds ratio [AOR], 1.70; 95% CI, 1.42-2.02), disorders of eye refraction and accommodation (AOR, 1.26; 95% CI, 1.09-1.47), visual disturbances (AOR, 1.31; 95% CI, 1.10-1.55), gastritis and duodenitis (AOR, 1.35; 95% CI, 1.08-1.70), patella disorders (AOR, 1.47; 95% CI, 1.13-1.90), heartbeat abnormalities (AOR, 1.94; 95% CI, 1.27-2.96), flatulence (AOR, 1.43; 95% CI, 1.01-2.01), skin sensation disturbances (AOR, 12.93; 95% CI, 8.98-18.62), as well as dizziness and giddiness (AOR, 1.52; 95% CI, 1.22-1.89). Four of these ICD-10-GM codes were significantly more prevalent in children and adolescents with MS than in controls with JIA: obesity (AOR, 3.19; 95% CI, 2.03-5.02), refraction and accommodation disorders (AOR, 3.08; 95% CI, 2.33-4.08), visual disturbances (AOR, 1.62; 95% CI, 1.13-2.33), and skin sensation disturbances (AOR, 27.70; 95% CI, 6.52-117.64).

CONCLUSIONS AND RELEVANCE: In this population-based, matched case-control study, children and adolescents with MS had diverse metabolic, ocular, musculoskeletal, gastrointestinal, and cardiovascular symptoms, signs, or diagnoses within 5 years before their first MS diagnosis. Better characterization of early symptoms and/or risk factors, comorbid disorders, and possible prodromal features of MS may have considerable implications for early recognition and subsequent progression of the disease.

PMID:39729316 | DOI:10.1001/jamanetworkopen.2024.52652

JAMA Netw Open. 2024 Dec 2;7(12):e2452661. doi: 10.1001/jamanetworkopen.2024.52661.

ABSTRACT

IMPORTANCE: Serial circulating tumor DNA (ctDNA) has emerged as a routine surveillance strategy for patients with resected colorectal cancer, but how serial ctDNA monitoring is associated with potential curative outcomes has not been formally assessed.

OBJECTIVE: To examine whether there is a benefit of adding serial ctDNA assays to standard-of-care imaging surveillance for potential curative outcomes in patients with resected colorectal cancer.

DESIGN, SETTING, AND PARTICIPANTS: In this single-center (City of Hope Comprehensive Cancer Center, Duarte, California), retrospective, case cohort study, patients with stage II to IV colorectal cancer underwent curative resection and were monitored with serial ctDNA assay and National Cancer Center Network (NCCN)-guided imaging surveillance from September 20, 2019, to April 3, 2024. The median duration of follow-up was 26 months (range, 2-54 months).

INTERVENTIONS: Serial ctDNA assays were performed every 3 months for 2 years and every 6 months for the 3 following years in conjunction with NCCN-guided radiographic surveillance.

MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of patients with clinical benefit from ctDNA testing, defined as the proportion of patients with a newly positive ctDNA assay and negative scheduled imaging (most recent or concurrent) that subsequently led to early imaging confirmation of recurrence, followed by curative-intent intervention with no evidence of recurrence at the time of data cutoff. Recurrence was categorized by ctDNA recurrence, radiographic recurrence, or concurrent ctDNA and imaging recurrence. Salvage resections and associated durable remissions were described within each of the 3 categories. Descriptive statistics were used to characterize the patient population.

RESULTS: In total, 184 patients (median age, 59 years [range, 32-88 years]; 97 female [52.7%]) were included in this study, and 129 (70.1%) had stage II to III disease. Forty-five patients (24.5%) had ctDNA or imaging-confirmed recurrence. Of these 45 patients, 14 had radiographic recurrence with negative ctDNA, and 11 had concurrent ctDNA and imaging recurrence. Twenty of 45 patients had ctDNA positivity with negative imaging at first ctDNA positivity; 6 had reflex imaging that was positive for recurrence, and 14 continued with serial imaging and ctDNA monitoring. Ten of 14 patients had subsequent recurrent disease, 3 patients had a spontaneous clearance of ctDNA, and 1 patient remained imaging negative 7 months after positive ctDNA, after which she was lost to follow-up. Altogether, 11 of 20 patients with ctDNA recurrence without initial concurrent imaging recurrence had subsequent metastasectomy, and only 3 were disease-free at the cutoff date in April 2024, representing 1.6% of the surveilled population.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with stage II to IV colorectal cancer who underwent curative-intent resection, the addition of serial tumor-informed ctDNA assay to the standard NCCN-recommended surveillance had limited clinical benefits. Additional prospective research is needed to clarify the value of ctDNA testing in the surveillance setting.

PMID:39729315 | DOI:10.1001/jamanetworkopen.2024.52661

Int J Environ Health Res. 2024 Dec 27:1-11. doi: 10.1080/09603123.2024.2446522. Online ahead of print.

ABSTRACT

Research on geographic and socioeconomic disparities of NO₂ attributed mortality burden is limited. This study aims to quantify the geographic and socioeconomic differences in the association between long-term exposure to NO₂ and mortality burden in China. We estimated the all-cause mortality burden of adults over 16 years old attributable to NO₂ exposure above 10 µg/m³ for 231 Chinese cities from 2015 to 2019, and geographic and socioeconomic differences . Attributed fraction (AF), attributed deaths (AD), attributed mortality rate (AMR) and total value of statistical life lost (VSL) were used as the mortality burden measurements. Between 2015 and 2019, we estimated 1356.3 thousand deaths (95% CI: 513.7-2050.7) attributed to NO₂ exposure above 10 µg/m³ per year and VSL of 958.2 billion USD (95% CI: 362.9-1448.8). Cities in the northern region, cities with high levels of GDP per capita (PGDP) and urbanization suffered the highest mortality burden and corresponding economic loss. Consequently, significant geographic and socioeconomic disparities of NO₂ attributed mortality burden exist across cities in China.

PMID:39729307 | DOI:10.1080/09603123.2024.2446522

JAMA Health Forum. 2024 Dec 6;5(12):e244594. doi: 10.1001/jamahealthforum.2024.4594.

ABSTRACT

IMPORTANCE: More than one-quarter of US residents live in states or localities that restrict sales of flavored electronic nicotine delivery systems (ENDS), often as a means to reduce youth vaping. Yet, how these policies affect young adult vaping and smoking remains unclear.

OBJECTIVE: To estimate the effects of ENDS flavor restrictions on ENDS use and cigarette smoking among young adults (age 18-29 years) in the US.

DESIGN, PARTICIPANTS, AND SETTING: This quasi-experimental analysis used annual survey data from the 2016 to 2023 Behavioral Risk Factor Surveillance System (BRFSS), a series of nationally- and state-representative, repeated cross-sectional surveys of noninstitutionalized civilian adults in the US. Two-way fixed-effects specifications were estimated to assess how ENDS flavor restrictions affect young adults’ use of ENDS and cigarettes. Analyses were adjusted for potential confounders including concurrent tobacco control policies, respondent demographic characteristics, and socioeconomic factors. Data analyses were conducted in November 2023 and repeated in October 2024 to incorporate newly released 2023 survey data.

MAIN OUTCOMES AND MEASURES: Current and daily use of ENDS and of cigarettes as measured in the BRFSS.

RESULTS: Balanced panel analyses of 242 154 individuals aged 18 to 29 years consistently found that state ENDS flavor restrictions were associated with statistically significant reductions in daily vaping and increases in daily cigarette smoking. Estimates were similar across robustness checks, with the main specification showing 3.6 (95% CI, -5.0 to -2.1) percentage point (ppt) reductions in daily vaping and 2.2 ppt increases in daily cigarette smoking (95% CI, 1.0 to 3.4) relative to changes in states without restrictions. These estimates are equivalent to an 80% reduction in daily vaping and 22% increase in daily smoking compared with 2018 mean rates.

CONCLUSIONS AND RELEVANCE: The findings of this quasi-experimental analysis of BRFSS survey data indicate that state restrictions on flavored ENDS sales were associated with reduced vaping among young adults but may have unintentionally increased cigarette smoking, potentially offsetting public health gains. These findings suggest that alleviating the burden of tobacco-related disease will require regulatory strategies that balance reducing vaping with preventing increases in more lethal, combustible tobacco use.

PMID:39729302 | DOI:10.1001/jamahealthforum.2024.4594