Category: Nevin Manimala

JAMA Pediatr. 2024 Sep 3. doi: 10.1001/jamapediatrics.2024.3274. Online ahead of print.

ABSTRACT

IMPORTANCE: Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs.

OBJECTIVE: To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits.

DESIGN, SETTING, AND PARTICIPANTS: The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed.

INTERVENTIONS: Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+.

MAIN OUTCOMES AND MEASURES: Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery.

RESULTS: A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31).

CONCLUSIONS AND RELEVANCE: In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04844021.

PMID:39226027 | DOI:10.1001/jamapediatrics.2024.3274

J Racial Ethn Health Disparities. 2024 Sep 3. doi: 10.1007/s40615-024-02161-3. Online ahead of print.

ABSTRACT

BACKGROUND: The study was conducted to investigate the relationship between pregnancy-related anxiety levels of primiparae living in an ethnic region and their readiness for postnatal hygienic care of newborns.

METHOD: The study conducted between February and May 2023 included 201 “18-40-year-old primiparae” who lived in an ethnic region and volunteered to participate in the study. The population of the study consisted of all pregnant women who presented to the Gynecology and Obstetrics Clinic, Pregnancy Outpatient Clinic of a city hospital. The “Pregnant Women Personality and Obstetric Characteristics Form,” “Pregnant Women’s Readiness for Newborn Hygienic Care Scale,” and “Spielberg State-Trait Anxiety Inventory” were used as data collection tools.

RESULTS: The mean age of the 201 primiparae participating in the study was 26.11 ± 3.05 years. Although 71.1% of them felt confident about baby care before the baby was born, 95.5% needed help with baby care after birth. Their readiness for stress and newborn hygienic care was at a “medium” level. There was a statistically significant negative relationship between the scores they obtained from the Pregnant Women’s Readiness for Newborn Hygienic Care Scale and Spielberg State-Trait Anxiety Inventory (p = 0.011; r = – 0.180).

CONCLUSIONS: The participating primiparae experienced moderate levels of anxiety, and the increase in their anxiety levels negatively affected their readiness for the hygienic care of their newborn babies. Thus, when primiparae are provided with healthy newborn care, their anxiety levels should.

PMID:39225966 | DOI:10.1007/s40615-024-02161-3

J Neurooncol. 2024 Sep 3. doi: 10.1007/s11060-024-04799-9. Online ahead of print.

ABSTRACT

PURPOSE: Depression and anxiety’s impact on glioma patient survival lacks consensus. Understanding these effects can highlight the importance of identifying depression and anxiety in glioma patients, and inform future treatments. This systematic review and meta-analysis aims to clarify the impact of depression and anxiety on glioma patient survival.

METHODS: We conducted a systematic literature search of major databases, including PubMed, Embase, Web of Science Core Collection, Cochrane Library, and PsycINFO, from inception to June 2023, to identify relevant studies. Eligible studies were those that examined the association between depression, anxiety, or both, and survival outcomes in glioma patients. Data were extracted and analyzed using fixed-effects meta-analysis models to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS: A total of 15 studies met the inclusion criteria, encompassing a diverse range of glioma patients across different clinical settings and stages. The meta-analysis revealed a statistically significant association between depression and reduced overall survival in glioma patients, with a pooled HR of 1.65 (95% CI: 1.41-1.83, 11 studies). The preliminary univariate meta-regression results indicate no impact of individual study characteristics on the effect size. Likewise, anxiety was associated with worse overall survival, with a pooled HR of 1.65 (95% CI: 1.18-2.31, 5 studies).

CONCLUSIONS: This meta-analysis underscores the vital need to identify and treat depression and anxiety in glioma patients. Future research should explore the underlying mechanisms, aiding the creation of interventions enhancing both mental health and clinical outcomes for this vulnerable group.

PMID:39225956 | DOI:10.1007/s11060-024-04799-9

Qual Life Res. 2024 Sep 3. doi: 10.1007/s11136-024-03733-w. Online ahead of print.

ABSTRACT

PURPOSE: Patients with urinary calculi undergo resource-intensive follow-up. Application of a PROM, Urinary Stones and Intervention Quality of Life (USIQoL), can potentially optimise current practices if it matches the outcomes of traditional follow-up. Our objective was to develop, and conduct, a preliminary validation of the USIQoL based prediction model to aid triage.

METHODS: We performed a two phase prospective cohort study. The 1st phase included development of the USIQoL-based decision model using multicentre data. The 2nd phase involved prospective single-blind external validation for the outpatient application. The aim was to evaluate correlations between the USIQoL scores and key predictors; clinical outcomes and global health ratings (EuroQoL EQ-5D). We used statistical analysis to validate USIQoL cut-off scores to aid triage and the decision to intervene.

RESULTS: Of 503 patients invited, 91% (n = 455, Development [305] and Validation [150]; M = 308, F = 147) participated. The relationship between USIQoL domain scores and clinical outcomes was consistently significant (estimated odds: PPH 1.24, p < 0.001, 95% CI 1.13-1.36; PSH 1.22, p < 0.001, 95% CI 1.12-1.33). The ROC values for the model were ≥ 0.75. The optimum domain cut-off scores were derived with rising scores implying increased need to intervene. The model demonstrated satisfactory sensitivity (0.81-0.89) and specificity (0.36-0.47).

CONCLUSIONS: The study demonstrates satisfactory correlation between the USIQoL and clinical outcomes making this model a valid aid for triage and optimising outpatient management with the cut-off scores able to identify high risk patients who need active treatment.

PMID:39225939 | DOI:10.1007/s11136-024-03733-w

Langenbecks Arch Surg. 2024 Sep 3;409(1):268. doi: 10.1007/s00423-024-03456-z.

ABSTRACT

PURPOSE: Augmented reality navigation in liver surgery still faces technical challenges like insufficient registration accuracy. This study compared registration accuracy between local and external virtual 3D liver models (vir3DLivers) generated with different rendering techniques and the use of the left vs right main portal vein branch (LPV vs RPV) for landmark setting. The study should further examine how registration accuracy behaves with increasing distance from the ROI.

METHODS: Retrospective registration accuracy analysis of an optical intraoperative 3D navigation system, used in 13 liver tumor patients undergoing liver resection/thermal ablation.

RESULTS: 109 measurements in 13 patients were performed. Registration accuracy with local and external vir3DLivers was comparable (8.76 ± 0.9 mm vs 7.85 ± 0.9 mm; 95% CI = -0.73 to 2.55 mm; p = 0.272). Registrations via the LPV demonstrated significantly higher accuracy than via the RPV (6.2 ± 0.85 mm vs 10.41 ± 0.99 mm, 95% CI = 2.39 to 6.03 mm, p < 0.001). There was a statistically significant positive but weak correlation between the accuracy (d_Feature) and the distance from the ROI (d_ROI) (r = 0.298; p = 0.002).

CONCLUSION: Despite basing on different rendering techniques both local and external vir3DLivers have comparable registration accuracy, while LPV-based registrations significantly outperform RPV-based ones in accuracy. Higher accuracy can be assumed within distances of up to a few centimeters around the ROI.

PMID:39225933 | DOI:10.1007/s00423-024-03456-z

Arch Dermatol Res. 2024 Sep 3;316(8):599. doi: 10.1007/s00403-024-03308-2.

NO ABSTRACT

PMID:39225855 | DOI:10.1007/s00403-024-03308-2

Naunyn Schmiedebergs Arch Pharmacol. 2024 Sep 3. doi: 10.1007/s00210-024-03385-0. Online ahead of print.

ABSTRACT

An underestimated worldwide health concern, Monkeypox (Mpox) is becoming a bigger menace to the world’s population. After smallpox was eradicated in 1970, Mpox was found in a rural region of Africa and quickly spread to other African countries. The etiological agent of the Mpox infection, the Mpox virus, is constantly evolving, and its capability for cross-species transmission led to a global outbreak in 2022 which led to several deaths throughout the world. This review aims to showcase the progressive treatment methods and emerging innovations in the diagnostic and prevention strategies for controlling Mpox. The clinical trial data for antiviral drugs were systematically collected and analyzed using statistical tests to determine the most effective antiviral treatment. Emerging viral protein inhibitors that are under investigation for Mpox treatment were also scrutinized in this review. Additionally, modern diagnostic methods, such as the Streamlined CRISPR On Pod Evaluation platform (SCOPE) and graphene quantum rods were reviewed, and the efficacy of mRNA vaccines with traditional smallpox vaccines used for Mpox were compared. The statistical analysis revealed that tecovirimat (TCV) is the most effective antiviral drug among the other evaluated drugs, showing superior efficacy in clinical trials. Similarly, mRNA vaccines offer greater effectiveness compared to conventional smallpox vaccines. Furthermore, emerging nanomedicine and herbal drug candidates were highlighted as potential future treatments for Mpox. The findings underscore the effectiveness of TCV in treating Mpox and highlight significant advancements in preventive treatments. The review also points to innovative approaches in vaccine technology and potential future therapies, including nanomedicine and herbal remedies, which may enhance Mpox management.

PMID:39225831 | DOI:10.1007/s00210-024-03385-0

Environ Monit Assess. 2024 Sep 3;196(10):884. doi: 10.1007/s10661-024-13057-4.

ABSTRACT

Groundwater depletion and water scarcity are pressing issues in water-limited regions worldwide, including Pakistan, where it ranks as the third-largest user of groundwater. Lahore, Pakistan, grapples with severe groundwater depletion due to factors like population growth and increased agricultural land use. This study aims to address the lack of comprehensive groundwater availability data in Lahore’s semi-arid region by employing GIS techniques and remote sensing data. Various parameters, including Land Use and Land Cover (LULC), Rainfall, Drainage Density (DD), Water Depth, Soil Type, Slope, Population Density, Road Density, Normalized Difference Vegetation Index (NDVI), Normalized Difference Built-Up Index (NDBI), Moisture Stress Index (MSI), Water Vegetation Water Index (WVWI), and Land Surface Temperature (LST), are considered. Thematic layers of these parameters are assigned different weights based on previous literature, reclassified, and superimposed in weighted overlay tool to develop a groundwater potential zones index map for Lahore. The groundwater recharge potential zones are categorized into five classes: Extremely Bad, Bad, Mediocre, Good, and Extremely Good. The groundwater potential zone index (GWPZI) map of Lahore reveals that the majority falls within the Bad to Mediocre recharge potential zones, covering 33% and 28% of the total land area in Lahore, respectively. Additionally, 14% of the total area falls under the category of Extremely Bad recharge potential zones, while Good to Extremely Good areas cover 19% and 6%, respectively. By providing policymakers and water supply authorities with valuable insights, this study underscores the significance of GIS techniques in groundwater management. Implementing the findings can aid in addressing Lahore’s groundwater challenges and formulating sustainable water management strategies for the city’s future.

PMID:39225827 | DOI:10.1007/s10661-024-13057-4

J Mol Med (Berl). 2024 Sep 3. doi: 10.1007/s00109-024-02475-z. Online ahead of print.

ABSTRACT

Epigenetic alterations play a pivotal role in conditions influenced by environmental factors such as overweight and obesity. Many of these changes are tissue-specific, which entails a problem in its study since obtaining human tissue is a complex and invasive practice. While blood is widely used as a surrogate biomarker, it cannot directly extrapolate the evidence found in blood to tissue. Moreover, the intricacies of metabolic diseases add a new layer of complexity, as obesity leads to significant alterations in adipose tissue, potentially causing associated pathologies that can disrupt existing correlations seen in healthy individuals. Here, our objective was to determine which epigenetic markers exhibit correlations between blood and adipose tissue, regardless of the metabolic status. We collected paired blood and adipose tissue samples from 64 patients with morbidity obesity and non-obese and employed the MethylationEPIC 850 K array for analysis. We found that only a small fraction, specifically 4.3% (corresponding to 34,825 CpG sites), of the sites showed statistically significant correlations (R ≥ 0.6) between blood and adipose tissue. Within this subset, 5327 CpG sites exhibited a strong correlation (R ≥ 0.8) between blood and adipose tissue. Our findings suggest that the majority of epigenetic markers in peripheral blood do not reliably reflect changes occurring in visceral adipose tissues. However, it is important to note that there exists a distinct set of epigenetic markers that can indeed mirror changes in adipose tissue within blood samples. KEY MESSAGES: More than 8% of methylation sites exhibit similarity between blood and adipose tissues, regardless of BMI The correlation percentage between blood and adipose tissue is strongly influenced by gender The principal genes implicated in this correlation are related to metabolism or the immunological system.

PMID:39225820 | DOI:10.1007/s00109-024-02475-z

Ophthalmic Physiol Opt. 2024 Sep 3. doi: 10.1111/opo.13386. Online ahead of print.

ABSTRACT

PURPOSE: To assess the visual impact of Diffusion Optics Technology™ 0.2 DOT lenses (SightGlass Vision Inc.) designed for myopia control on primary gaze. DOT spectacle lenses contain light scattering elements that scatter light as it passes through the lens which, in turn, reduces retinal image contrast.

METHODS: Fifty-one children (12.2 ± 1.3, range 10-14 years; 51% females) were randomly assigned to wear DOT spectacle (n = 27) or single vision lenses (n = 24) across six investigational sites in North America. Binocular high- and low-contrast distant visual acuities, near visual acuity, reading speed, contrast sensitivity, stereoacuity and glare were assessed in primary gaze after at least 3 years of wear, with the study 95% powered in all metrics to detect significant differences between the groups.

RESULTS: Mean binocular distance high-contrast (-0.09 ± 0.02 vs. -0.08 ± 0.02 logMAR, p = 0.81), low-contrast (0.05 ± 0.02 vs. 0.07 ± 0.02 logMAR, p = 0.52) and near visual acuity with glare sources (-0.06 ± 0.03 vs. -0.09 ± 0.03 logMAR, p = 0.32) were similar for DOT and single vision lens wearers, respectively. Contrast sensitivity was similar between children wearing DOT or single vision lenses across 11 of the 16 spatial frequencies (p > 0.05). Mean stereopsis was similar (p = 0.30) with the DOT lenses (33.2 ± 12.5″) and single vision lenses (38.1 ± 14.2″). Functional reading speed metrics were similar in both study groups, as was the objectively measured head tilt during reading (p > 0.05). The mean halo radius was 0.56° ± 0.17° with the DOT lenses compared with 0.50° ± 0.12° with single vision lenses (p = 0.02), but the statistically significant difference was smaller than the non-inferiority bound of 0.4°.

CONCLUSION: Diffusion optics technology lenses provide a clinically equivalent visual experience to a standard single vision lens.

PMID:39225035 | DOI:10.1111/opo.13386