Category: Nevin Manimala

Clin Exp Otorhinolaryngol. 2024 Mar 19. doi: 10.21053/ceo.2024.00025. Online ahead of print.

ABSTRACT

OBJECTIVES: No study has evaluated the degree of contamination after the total disassembly of continuous positive-airway pressure (CPAP) devices. We assessed the extent of contamination of the CPAP device by disassembling the system and identifying the factors that influence the degree of CPAP contamination, which is applied daily in patients with obstructive sleep apnea (OSA).

METHODS: Chart review of the medical records of patients with OSA who underwent disassembly and cleaning of the CPAP device was performed by two skilled technicians who photographed the levels of contamination of each component and scored them using a visual analog scale. Clinical characteristics and records of CPAP device usage were statistically analyzed to determine the characteristics that were significantly associated with the degree of CPAP device contamination.

RESULTS: Among the 55 participants, not only the external components, including the mask and tube, but also the internal components, such as the humidifier and the interior of the main body, showed a substantial degree of contamination. The total and average daily duration of usage of the CPAP device were not significantly associated with the degree of contamination. Age was most frequently associated with the degree of contamination, such as in masks, humidifiers, and interior and exterior main parts. The degree of contamination of the internal components of the device was significantly correlated with the degree of contamination of the external components.

CONCLUSION: Age-specific guidelines for hygiene management of the external and internal CPAP components should be prepared.

PMID:38499436 | DOI:10.21053/ceo.2024.00025

Trends Neurosci Educ. 2024 Mar;34:100221. doi: 10.1016/j.tine.2024.100221. Epub 2024 Feb 1.

ABSTRACT

BACKGROUND: Educational neuromyths are known to exist amongst teachers in Western countries, and some researchers argue that neuromyths may affect classroom teaching.

METHOD: An online survey was designed and distributed to sixty-four Hong Kong inclusive education teachers. Descriptive statistics, Pearson’s correlation, Hierarchical Multiple Regression, and Thematic analysis were used to analyzed the collected data.

RESULTS: First, there is a relatively low prevalence of neuromyths among Hong Kong teachers. Second, neuromyths were not significantly correlated with inclusive teachers’ instructional practices. Third, teachers’ general knowledge of the brain was significantly correlated with neuromyths and is a significant predictor of neuromyths. Fourth, the work-related stress of teachers was the main barrier to learning about neuroscience and adopting evidence-based practices in classroom teaching in Hong Kong.

CONCLUSION: Our findings raise awareness of environmental and cultural factors that need to be considered and might affect the prevalence of neuromyths studies in non-WEIRD contexts.

PMID:38499408 | DOI:10.1016/j.tine.2024.100221

Int J Epidemiol. 2024 Feb 14;53(2):dyae033. doi: 10.1093/ije/dyae033.

ABSTRACT

BACKGROUND: In descriptive epidemiology, there are strong similarities between incidence and survival analyses. Because of the success of multidimensional penalized splines (MPSs) in incidence analysis, we propose in this pedagogical paper to show that MPSs are also very suitable for survival or net survival studies.

METHODS: The use of MPSs is illustrated in cancer epidemiology in the context of survival trends studies that require specific statistical modelling. We focus on two examples (cervical and colon cancers) using survival data from the French cancer registries (cases 1990-2015). The dynamic of the excess mortality hazard according to time since diagnosis was modelled using an MPS of time since diagnosis, age at diagnosis and year of diagnosis. Multidimensional splines bring the flexibility necessary to capture any trend patterns while penalization ensures selecting only the complexities necessary to describe the data.

RESULTS: For cervical cancer, the dynamic of the excess mortality hazard changed with the year of diagnosis in opposite ways according to age: this led to a net survival that improved in young women and worsened in older women. For colon cancer, regardless of age, excess mortality decreases with the year of diagnosis but this only concerns mortality at the start of follow-up.

CONCLUSIONS: MPSs make it possible to describe the dynamic of the mortality hazard and how this dynamic changes with the year of diagnosis, or more generally with any covariates of interest: this gives essential epidemiological insights for interpreting results. We use the R package survPen to do this type of analysis.

PMID:38499394 | DOI:10.1093/ije/dyae033

Psychogeriatrics. 2024 Mar 18. doi: 10.1111/psyg.13103. Online ahead of print.

ABSTRACT

BACKGROUND: Throughout the COVID-19 pandemic, older Canadians were the most at risk of severe physical harm, including death, and their return to post-COVID life was expected to be especially anxiety-provoking. A study was conducted to obtain nationally representative evidence of older Canadians’ self-perceived anxiety levels and their strategies to manage or mitigate it as public health restrictions were lifting.

MATERIALS AND METHODS: This study had a cross-sectional descriptive design. An e-survey was used to collect data from 1327 Canadians aged 60+ stratified by age, sex, and education to resemble the larger general population. Participants completed the Geriatric Anxiety Scale (GAS-10) and indicated which of the 16 Centre for Addictions and Mental Health’s (2022) Coping with Stress and Anxiety strategies they were using to manage or mitigate their anxiety when social distancing was lifting. Descriptive statistics, Pearson correlation, and multiple regression analysis were used to explore the data.

RESULTS: While, on average, older Canadians were mildly anxious, nearly one-quarter of responders rated their anxiety as severe. Age, sex, perceived health, were statistically significant correlates of anxiety. Six coping strategies were associated with significantly lower anxiety scores. Moreover, accepting some fear and anxiety as normal, challenging worries and anxious thoughts, and practising relaxation/meditation appeared to increase anxiety.

CONCLUSION: Older Canadians used multiple strategies to manage or mitigate their anxiety, and seemingly, with more successful than detrimental tries. Practitioners have much to learn and understand about older people’s mental health promotion efforts after social distancing, now and for future pandemics.

PMID:38499385 | DOI:10.1111/psyg.13103

Br J Gen Pract. 2024 Mar 18:BJGP.2023.0180. doi: 10.3399/BJGP.2023.0180. Online ahead of print.

ABSTRACT

BACKGROUND: Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention’s active ingredient.

AIM: To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success.

DESIGN AND SETTING: A systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published in 22 publications from 2009 to 2019.

METHOD: A search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion criteria were: sample mainly aged ≥65 years; delivered in primary care; and non-disease-specific interventions. Exclusion criteria were: non-RCTs; primarily pharmacological or psychological interventions; and where outcomes of interest were not reported. Risk of bias was assessed using the original Cochrane tool. Outcomes examined were healthcare use including admissions to hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH).

RESULTS: Many studies had a mix of patient-, provider-, and practice-focused intervention components (13 of 18 studies). Studies included in the review had low-to-moderate risk of bias. Interventions had no overall benefit to healthcare use (including admissions to hospital and ARC) but higher basic ADL scores were observed (standardised mean difference [SMD] 0.21, 95% confidence interval [CI] = 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, 95% CI = 1.01 to 1.37). When intervention effects were examined by components, better patient-reported outcomes were observed in studies that changed the care setting (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.17, 95% CI = 1.01 to 1.37), included educational components for health professionals (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.27, 95% CI = 1.05 to 1.55), and provided patient education (SMD for basic ADLs 0.28, 95% CI = 0.09 to 0.48). Additionally, admissions to hospital in intervention participants were fewer by 23% in studies that changed the care setting (incidence rate ratio [IRR] 0.77, 95% CI = 0.63 to 0.95) and by 26% in studies that provided patient education (IRR 0.74, 95% CI = 0.56 to 0.97).

CONCLUSION: Preventive primary care interventions are beneficial to older people’s functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.

PMID:38499364 | DOI:10.3399/BJGP.2023.0180

BMJ Paediatr Open. 2024 Mar 18;8(1):e002240. doi: 10.1136/bmjpo-2023-002240.

ABSTRACT

OBJECTIVES: This study aimed to explore the effects of short birth spacing (SBS), which is defined as a period of less than 33 months between two successive births, on multiple concurrent forms of child malnutrition (MCFCM) and at least one form of child malnutrition (ALOFCM) using propensity score matching (PSM).

METHODS: This study used data extracted from the 2017-18 Bangladesh Demographic and Health Survey. PSM with four different distance functions, including logistic regression, classification and regression tree, single hidden layer neural network and random forest, were performed to evaluate the effects of SBS on MCFCM and ALOFCM. We also explored how the effects were modified in different subsamples, including women’s empowerment, education and economic status (women’s 3E index)-constructed based on women’s decision-making autonomy, education level, and wealth index, and age at marriage, and place of residence.

RESULTS: The prevalence of SBS was 22.16% among the 4652 complete cases. The matched samples of size 2062 generated by PSM showed higher odds of MCFCM (adjusted OR (AOR)=1.25, 95% CI=1.02 to 1.56, p=0.038) and ALOFCM (AOR=1.20, 95% CI=1.01 to 1.42, p=0.045) for the SBS children compared with their counterparts. In the subsample of women with 3E index≥50% coverage, the SBS children showed higher odds of MCFCM (AOR: 1.43, 95% CI=1.03 to 2.00, p=0.041] and ALOFCM (AOR: 1.33, 95% CI=1.02 to 1.74, p=0.036). Higher odds of MCFCM (AOR=1.27, 95% CI=1.02 to 1.58, p=0.036) and ALOFCM (AOR=1.23, 95% CI=1.02 to 1.51, p=0.032) for SBS children than normal children were also evident for the subsample of mothers married at age≤18 years.

CONCLUSION: SBS was significantly associated with child malnutrition, and the effect was modified by factors such as women’s autonomy and age at marriage.

PMID:38499349 | DOI:10.1136/bmjpo-2023-002240

Thorax. 2024 Mar 18:thorax-2023-220436. doi: 10.1136/thorax-2023-220436. Online ahead of print.

ABSTRACT

RATIONALE: Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented.

OBJECTIVE: To document lung function trajectories from childhood to mid-adult life.

METHODS: We modelled forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45.

RESULTS: Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV₁ trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV₁/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV₁ trajectories leading to the lowest FEV₁ values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45.

CONCLUSIONS: Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.

PMID:38499347 | DOI:10.1136/thorax-2023-220436

BMJ Open Ophthalmol. 2024 Mar 18;9(1):e001608. doi: 10.1136/bmjophth-2023-001608.

ABSTRACT

OBJECTIVE: To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.

METHODS: A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.

RESULTS: Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF.

CONCLUSION: Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.

PMID:38499344 | DOI:10.1136/bmjophth-2023-001608

Stat Methods Med Res. 2024 Mar 18:9622802241236952. doi: 10.1177/09622802241236952. Online ahead of print.

ABSTRACT

Existing methods that use propensity scores for heterogeneous treatment effect estimation on non-experimental data do not readily extend to the case of more than two treatment options. In this work, we develop a new propensity score-based method for heterogeneous treatment effect estimation when there are three or more treatment options, and prove that it generates unbiased estimates. We demonstrate our method on a real patient registry of patients in Singapore with diabetic dyslipidemia. On this dataset, our method generates heterogeneous treatment recommendations for patients among three options: Statins, fibrates, and non-pharmacological treatment to control patients’ lipid ratios (total cholesterol divided by high-density lipoprotein level). In our numerical study, our proposed method generated more stable estimates compared to a benchmark method based on a multi-dimensional propensity score.

PMID:38499338 | DOI:10.1177/09622802241236952

J Med Genet. 2024 Mar 18:jmg-2023-109750. doi: 10.1136/jmg-2023-109750. Online ahead of print.

ABSTRACT

BACKGROUND: As gene-specific therapy for inherited retinal dystrophy (IRD) advances, unified variant interpretation across institutes is becoming increasingly important. This study aims to update the genetic findings of 86 retinitis pigmentosa (RP)-related genes in a large number of Japanese patients with RP by applying the standardised variant interpretation guidelines for Japanese patients with IRD (J-IRD-VI guidelines) built upon the American College of Medical Genetics and Genomics and the Association for Molecular Pathology rules, and assess the contribution of these genes in RP-allied diseases.

METHODS: We assessed 2325 probands with RP (n=2155, including n=1204 sequenced previously with the same sequencing panel) and allied diseases (n=170, newly analysed), including Usher syndrome, Leber congenital amaurosis and cone-rod dystrophy (CRD). Target sequencing using a panel of 86 genes was performed. The variants were interpreted according to the J-IRD-VI guidelines.

RESULTS: A total of 3564 variants were detected, of which 524 variants were interpreted as pathogenic or likely pathogenic. Among these 524 variants, 280 (53.4%) had been either undetected or interpreted as variants of unknown significance or benign variants in our earlier study of 1204 patients with RP. This led to a genetic diagnostic rate in 38.6% of patients with RP, with EYS accounting for 46.7% of the genetically solved patients, showing a 9% increase in diagnostic rate from our earlier study. The genetic diagnostic rate for patients with CRD was 28.2%, with RP-related genes significantly contributing over other allied diseases.

CONCLUSION: A large-scale genetic analysis using the J-IRD-VI guidelines highlighted the population-specific genetic findings for Japanese patients with IRD; these findings serve as a foundation for the clinical application of gene-specific therapies.

PMID:38499336 | DOI:10.1136/jmg-2023-109750