Category: Nevin Manimala

JAMA Dermatol. 2023 Dec 6. doi: 10.1001/jamadermatol.2023.4889. Online ahead of print.

ABSTRACT

IMPORTANCE: Symptomatic oral lichen planus (OLP) can be challenging to treat.

OBJECTIVE: To compare the efficacy of oral acitretin plus topical triamcinolone acetonide (TAC), 0.1%, with TAC monotherapy in patients with symptomatic OLP.

DESIGN, SETTING, AND PARTICIPANTS: This monocentric, investigator-initiated, placebo-controlled, investigator- and patient-blinded randomized clinical trial was conducted from December 2018 to June 2020 at the Postgraduate Institute of Medical Education and Research, a tertiary referral center in Chandigarh, India. Sixty-four patients 18 years or older with symptomatic OLP were recruited by consecutive sampling. Data were analyzed from July to December 2020.

INTERVENTION: The patients were randomized to receive either a combination of oral acitretin (25-35 mg/d) and TAC (treatment group) or TAC in combination with placebo (placebo group) for 28 weeks, with an additional 8 weeks of treatment-free follow-up after the end of treatment (36 weeks of total study duration).

MAIN OUTCOMES AND MEASURES: The disease severity and treatment response were assessed using Oral Disease Severity Score (ODSS), Oral Health Impact Profile 14 (OHIP-14), and visual analog scale (VAS). The primary aim was to assess the number of patients achieving ODSS-75 (75% reduction in ODSS compared with baseline) in both groups at 28 weeks and at the end of 36 weeks.

RESULTS: Among 64 patients, 31 in the treatment group and 30 in the placebo group completed the study (mean [SD] age, 50.6 [15.2] years vs 49.2 [14.4] years; male-female ratio, 13:19 vs 16:16). Baseline ODSS, visual analog scale, and Oral Health Impact Profile 14 scores were comparable in both groups. In the intention-to-treat analysis, there was a statistically significant higher number of patients achieving 75% or higher reduction in ODSS in the treatment group compared with the placebo group at the end of 28 weeks (28 [88%] vs 15 [47%], a 41 [95% CI, 20-61] percentage point difference between groups; P < .001; Cramér V = 0.47) and 36 weeks (27 [84%] vs 13 [41%], a 43 [95% CI, 23-67] percentage point difference between groups; P < .001; Cramér V = 0.47). Relapses during the posttreatment follow-up of 8 weeks were low among patients in both treatment and placebo groups (1 [3%] vs 2 [6%], a 3 [95% CI, -13 to 7] percentage point difference between groups; P > .99; Cramér V = 0.07).

CONCLUSION AND RELEVANCE: In this randomized clinical trial, the combination of oral acitretin and TAC was more effective than TAC monotherapy in patients with symptomatic OLP.

TRIAL REGISTRATION: Clinical Trial Registry of India Identifier: CTRI/2018/11/016448.

PMID:38055232 | DOI:10.1001/jamadermatol.2023.4889

J Healthc Manag. 2023 Dec 4. doi: 10.1097/JHM-D-23-00105. Online ahead of print.

ABSTRACT

GOAL: Rising incidents of violence and mistreatment of healthcare workers by patients and visitors have been reported. U.S. healthcare workers are five times more likely to experience nonfatal workplace violence (WPV) than workers in any other profession. However, less is known about the national trends in the incidence of violence and mistreatment in healthcare. The specific organizational and individual-level factors that relate to stress arising from these occurrences specifically by patients and family members are also not fully understood. The goals of this study were to examine national trends of violence toward healthcare workers, understand which populations are most vulnerable to stress from violence and mistreatment, and explore organizational factors that are related to these occurrences.

METHODS: Data were collected from three sources: (1) The Bureau of Labor Statistics Intentional Injury by Another Person data for the period 2011-2020, (2) data from a large national workers’ compensation claim services provider for the period 2018-2022, and (3) results from a survey distributed at a large medical center in June and July 2022. Data were represented graphically and analyzed using multivariate regression and dominance analysis to identify specific predictors of WPV and mistreatment among healthcare workers.

PRINCIPAL FINDINGS: Of the total surveyed sample, 23.7% of participants reported mistreatment from patients or visitors as a major stressor and 14.6% reported WPV from patients or visitors as a major stressor. Stress from mistreatment and WPV was most frequently reported by nurses, employees aged 18 to 24 years other than nurses, those who identified as White, and those who identified as female or a gender minority. The emergency room (ER) showed the highest percentages of stress from mistreatment (61.8%) and violence (55.9%) from patients or visitors. The top predictors of stress from WPV and mistreatment by patients or visitors among healthcare workers ranked high to low were working in the ER, working as a nurse, a lack of necessary supplies or equipment, patient or visitor attitudes or beliefs about COVID-19, and working in a hospital-based unit.

PRACTICAL APPLICATIONS: In addition to protecting employees as a moral imperative, preventing WPV is critical for organizational performance. Employee productivity is estimated to decrease up to 50% in the 6 to 18 weeks following an incident of violence, while turnover can increase 30% to 40%. An effective WPV prevention plan and a proactive approach to supporting the physical and mental health conditions that may result from WPV can mitigate the potential costs and exposures from these incidents. Organizations must also set clear expectations of behavior with patients and visitors by refusing to tolerate violence and mistreatment of caregivers. The impact of WPV can remain present and active for up to 8 years following an incident. Policy-level interventions are also needed. Currently, there are no federal protections for healthcare workers related to violence, though some states have made it a felony to abuse healthcare workers.

PMID:38055205 | DOI:10.1097/JHM-D-23-00105

J Child Adolesc Psychopharmacol. 2023 Dec 7. doi: 10.1089/cap.2023.0048. Online ahead of print.

ABSTRACT

Objective: To evaluate the efficacy and safety of escitalopram (ESC) in a 48-week relapse prevention study in Japanese adolescents with major depressive disorder (MDD). Methods: This was a 48-week multicenter randomized double-blind placebo-controlled parallel-group study of patients aged 12-17 years with MDD. Patients received ESC for 12 weeks as an open-label treatment period (open-label period). Patients who achieved criteria for remission or response in the open-label period received either ESC or placebo for 36 weeks as a double-blind treatment period (double-blind period). The primary endpoint was the time to relapse during the double-blind period. Safety was evaluated in terms of type, incidence, and severity of adverse events. Results: Of the 128 patients who entered the open-label period, 80 patients entered the double-blind period, all of whom were in the primary analysis population. The primary endpoint, time to relapse, was marginally less than statistically significant between the ESC and placebo groups (p = 0.051, log-rank test). In the Cox proportional hazards model, the estimated hazard ratio [two-sided 95% confidence interval] for relapse in the placebo group versus the ESC group was 2.96 [0.94, 9.30]. There were statistically significant differences between the ESC and placebo groups in several secondary endpoints (change in Children’s Depression Rating Scale-Revised, change in Clinical Global Impressions-Severity Scale, etc.). No notable safety/tolerability issues were observed in this study compared with the results of studies in Japanese adults with MDD. Conclusions: Superiority of ESC over placebo for relapse prevention in Japanese adolescents aged 12-17 years with MDD could not be verified with time to relapse evaluated by log-rank test. However, secondary endpoint results and a post hoc analysis of time to relapse suggest that ESC may be effective in preventing MDD relapse. No notable safety/tolerability issues were observed compared with the results of studies in Japanese adults with MDD. Study Registry Number: jRCT2080224520.

PMID:38055198 | DOI:10.1089/cap.2023.0048

Environ Sci Pollut Res Int. 2023 Dec 6. doi: 10.1007/s11356-023-31117-z. Online ahead of print.

ABSTRACT

Nigeria has struggled to meet sustainable development goals (SDGs) on environmental sustainability, transportation, and petroleum product distribution for decades, endangering human and ecological health. Petroleum product spills contaminate soil, water, and air, harming humans, aquatic life, and biodiversity. The oil and gas industry contributes to environmental sustainability and scientific and technological advancement through its supply chain activities in the transport and logistics sectors. This paper reviewed the effects of petroleum product transportation at three accident hotspots on Nigeria highway, where traffic and accident records are alarming due to the road axis connecting the southern and northern regions of the country. The preliminary data was statistically analysed to optimise the review process and reduce risk factors through ongoing data monitoring. Studies on Nigeria’s petroleum product transportation spills and environmental impacts between the years 2013 and 2023 were critically analysed to generate updated information. The searches include Scopus, PubMed, and Google Scholar. Five hundred and forty peer-reviewed studies were analysed, and recommendations were established through the conclusions. The findings show that petroleum product transport causes heavy metal deposition in the environment as heavy metals damage aquatic life and build up in the food chain, posing a health risk to humans. The study revealed that petroleum product spills have far-reaching environmental repercussions and, therefore, recommended that petroleum product spills must be mitigated immediately. Furthermore, the study revealed that better spill response and stricter legislation are needed to reduce spills, while remediation is necessary to lessen the effects of spills on environmental and human health.

PMID:38055166 | DOI:10.1007/s11356-023-31117-z

Ir J Med Sci. 2023 Dec 6. doi: 10.1007/s11845-023-03577-2. Online ahead of print.

ABSTRACT

BACKGROUND: Human brucellosis, which is endemic in the eastern region of Turkey, infects the reticulo-endothelial system. Acute brucellosis may cause hepatomegaly or splenomegaly.

AIMS: The main purpose of this study was to investigate the effectiveness of the point shear wave elastography (pSWE) method in identifying and detecting liver and spleen stiffness in acute brucellosis.

METHODS: This case-control study included 40 patients with acute brusellosis and 60 healthy individuals as a control group. The demographic data, abdominal ultrasonography (USG) and pSWE results of the patient and control groups were evaluated. Statistical and ROC analyses were performed.

RESULTS: The liver pSWE value was 3.8395 ± 1.171 kPa in the patient group and 1.6619 ± 0.495 kPa in the control group. The spleen pSWE value was 3.2431 ± 1.803 kPa in the patient group and 1.3793 ± 0.622 kPa in the control group. The mean liver and spleen pSWE values were statistically significantly higher in the patient group than in the control group (p < 0.001). Cut-off values were determined as 2.524 for the liver pSWE and 1.62667 for the spleen pSWE. From the AUC values (0.959, 0.903), the diagnostic performance of liver and spleen pSWE values were seen to be excellent in distinguishing between patient and control groups.

CONCLUSIONS: The study results showed that liver and spleen stiffness were high in acute brucellosis patients and had predictive significance above certain cut-off values. It can be considered that pSWE, which evaluates liver and spleen stiffness in acute brucellosis, may provide diagnostic benefit as a reliable, non-invasive technique.

PMID:38055148 | DOI:10.1007/s11845-023-03577-2

Endocrine. 2023 Dec 6. doi: 10.1007/s12020-023-03621-2. Online ahead of print.

ABSTRACT

PURPOSE: Runx2 and osteocalcin have pivotal roles in bone homeostasis. Polymorphism of these two genes could alter the function of osteoblasts and consequently bone mineral density (BMD). Attempts to understand the relationship between these polymorphisms and BMD in postmenopausal women across a variety of populations have yielded inconsistent results. This meta-analysis seeks to define the relationship between these polymorphisms with BMD in postmenopausal women.

METHODS: Eligible studies were identified from three electronic databases. Data were extracted from the eligible studies (4 studies on Runx2 and 6 studies on osteocalcin), and associations of Runx2 T > C and osteocalcin HindIII polymorphisms with BMD in postmenopausal women were assessed using standard difference in means (SDM) and 95% confidence intervals (CI) as statistical measures.

RESULTS: A significant difference in the lumbar spine (LS) BMD in postmenopausal women was observed between the TT and CC homozygotes for the Runx2 T > C (SDM = -0.445, p-value = 0.034). The mutant genotypes (CC) showed significantly lower LS BMD in comparison to wild type genotypes under recessive model of genetic analysis (TC + TT vs. CC: SDM = -0.451, p-value = 0.032). For osteocalcin, HindIII polymorphism, the mutant genotypes (HH) was associated with significantly higher BMD for both LS and femoral neck (FN) than the wild type (hh) homozygotes (SDM = 0.152, p-value = 0.008 and SDM = 0.139, p-value = 0.016 for LS and FN, respectively). There was no association between total hip (TH) BMD and the osteocalcin HindIII polymorphism.

CONCLUSIONS: Runx2 T > C and osteocalcin HindIII polymorphisms influence the level of BMD in postmenopausal women and may be used as predictive markers of osteoporosis.

PMID:38055125 | DOI:10.1007/s12020-023-03621-2

Health Care Manag Sci. 2023 Dec 6. doi: 10.1007/s10729-023-09661-4. Online ahead of print.

ABSTRACT

In the wake of hospital reforms introduced in 2011 in Turkey, public hospitals were grouped into associations with joint management and some shared operational and administrative functions, similar in some ways to hospital trusts in the English National Health Service. Reorganization of public hospitals effect hospital and market area characteristics and existence of hospitals. The objective of this study is to examine the effect of closure on competitive hospital performances. Using administrative data from Turkish Public Hospital Statistical Yearbooks for the years 2005 to 2007 and 2014 to 2017, we conducted a three-step efficiency analysis by incorporating data envelopment analysis (DEA) and propensity score matching techniques, followed by a difference-in-differences (DiD) regression. First, we used bootstrapped DEA to calculate the efficiency scores of hospitals that were located near hospitals that had been closed. Second, we used nearest neighbour propensity score matching to form control groups and ensure that any differences between these and the intervention groups could be attributed to being near a hospital that had closed rather than differences in hospital and market area characteristics. Lastly, we employed DiD regression analysis to explore whether being near a closed hospital had an impact on the efficiency of the surviving hospitals while considering the effect of the 2011 hospital reform policies. To shed light on a potential time lag between hospital closure and changes in efficiency, we used various periods for comparison. Our results suggest that the efficiency of public hospitals in Turkey increased in hospitals that were located near hospitals that closed in Turkey from 2011. Hospital closure improves the efficiency of competitive hospitals under hospital market reforms. Future studies may wish to examine the efficiency effects of government and private sector collaboration on competition in the hospital market.

PMID:38055110 | DOI:10.1007/s10729-023-09661-4

Behav Brain Sci. 2023 Dec 6;46:e408. doi: 10.1017/S0140525X23001784.

ABSTRACT

The dissociation between statistical prediction and scientific explanation advanced by Bowers et al. for studies of vision using deep neural networks is also observed in several other domains of behavior research, and is in fact unavoidable when fitting large models such as deep nets and other supervised learners, with weak theoretical commitments, to restricted samples of highly stochastic behavioral phenomena.

PMID:38054355 | DOI:10.1017/S0140525X23001784

Int J Eat Disord. 2023 Dec 6. doi: 10.1002/eat.24107. Online ahead of print.

ABSTRACT

OBJECTIVE: This study explored the relationship between unhealthy weight control behaviors (UWCBs) and their associated economic costs among adolescents using the 2014-2018 Longitudinal Study of Australian Children (LSAC).

METHODS: LSAC data in Wave 6 (n = 3538 adolescents aged 14-15 years), Wave 7 n = 3089 adolescents aged 16-17 years), and Wave 8 (n = 3037 adolescents aged 18-19 years) were derived from a representative sample of Australian adolescents. UWCBs were measured using the self-reported Branched Eating Disorder Test questionnaire. UWCBs were sub-classified into having fasting behaviors, using weight loss supplements or purging behaviors. Economic costs include healthcare and productivity costs to caregivers. Healthcare costs were measured using data from the Medicare and Pharmaceutical Benefits, which includes both medical and pharmaceutical costs. Productivity losses were measured using caregivers’ lost leisure time due to UWCBs among adolescents.

RESULTS: The mixed effect model identified statistically significant higher economic costs (mean difference = $453, 95% CIs $154, $752), higher health care costs (mean difference = $399, 95% CIs $102, $695), and higher productivity costs (mean difference = $59, 95% CIs $29, $90) for adolescents with UWCBs compared to their peers with no UWCBs. Subgroup analysis revealed that higher costs were associated with fasting and purging behaviors.

DISCUSSION: UWCBs were associated with increased economic costs during adolescence. Our finding suggests there should be a policy focus on tackling UWCBs to reduce the economic burden on the healthcare system and society.

PUBLIC SIGNIFICANCE: The study contributes to existing knowledge by investigating the direct healthcare costs and productivity losses associated with unhealthy weight control behaviors in Australian adolescents (14-18 years old) using a dataset that follows Australian adolescents over time. We found that engaging in unhealthy weight control behaviors such as fasting, using weight loss supplements, and purging was linked to higher costs among adolescents, suggesting policies should focus on addressing these behaviors.

PMID:38054343 | DOI:10.1002/eat.24107

Behav Brain Sci. 2023 Dec 6;46:e396. doi: 10.1017/S0140525X23001541.

ABSTRACT

Deep convolutional networks exceed humans in sensitivity to local image properties, but unlike biological vision systems, do not discover and encode abstract relations that capture important properties of objects and events in the world. Coupling network architectures with additional machinery for encoding abstract relations will make deep networks better models of human abilities and more versatile and capable artificial devices.

PMID:38054331 | DOI:10.1017/S0140525X23001541