Category: Nevin Manimala

JAMA Dermatol. 2023 May 10. doi: 10.1001/jamadermatol.2023.0975. Online ahead of print.

ABSTRACT

IMPORTANCE: Quality of life (QOL) of patients with atopic dermatitis (AD) is reported to be the lowest among skin diseases. To our knowledge, mindfulness and self-compassion training has not been evaluated for adults with AD.

OBJECTIVE: To evaluate the efficacy of mindfulness and self-compassion training in improving the QOL for adults with AD.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial conducted from March 2019 through October 2022 included adults with AD whose Dermatology Life Quality Index (DLQI) score, a skin disease-specific QOL measure, was greater than 6 (corresponding to moderate or greater impairment). Participants were recruited from multiple outpatient institutes in Japan and through the study’s social media outlets and website.

INTERVENTIONS: Participants were randomized 1:1 to receive eight 90-minute weekly group sessions of online mindfulness and self-compassion training or to a waiting list. Both groups were allowed to receive any dermatologic treatment except dupilumab.

MAIN OUTCOMES AND MEASURES: The primary outcome was the change in the DLQI score from baseline to week 13. Secondary outcomes included eczema severity, itch- and scratching-related visual analog scales, self-compassion and all of its subscales, mindfulness, psychological symptoms, and participants’ adherence to dermatologist-advised treatments.

RESULTS: The study randomized 107 adults to the intervention group (n = 56) or the waiting list (n = 51). The overall participant mean (SD) age was 36.3 (10.5) years, 85 (79.4%) were women, and the mean (SD) AD duration was 26.6 (11.7) years. Among participants from the intervention group, 55 (98.2%) attended 6 or more of the 8 sessions, and 105 of all participants (98.1%) completed the assessment at 13 weeks. The intervention group demonstrated greater improvement in the DLQI score at 13 weeks (between-group difference estimate, -6.34; 95% CI, -8.27 to -4.41; P < .001). The standardized effect size (Cohen d) at 13 weeks was -1.06 (95% CI, -1.39 to -0.74). All secondary outcomes showed greater improvements in the intervention group than in the waiting list group.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of adults with AD, integrated online mindfulness and self-compassion training in addition to usual care resulted in greater improvement in skin disease-specific QOL and other patient-reported outcomes, including eczema severity. These findings suggest that mindfulness and self-compassion training is an effective treatment option for adults with AD.

TRIAL REGISTRATION: https://umin.ac.jp/ctr Identifier: UMIN000036277.

PMID:37163257 | DOI:10.1001/jamadermatol.2023.0975

Clin Pharmacol Ther. 2023 May 10. doi: 10.1002/cpt.2936. Online ahead of print.

ABSTRACT

Using pharmacogenetics (PGx) to inform clinical decision making can benefit patients but clinical use of PGx testing has been limited. Existing genetics data obtained in the course of research could be used to identify patients who are suspected, but have not yet been confirmed, to carry clinically actionable genotypes, in whom confirmatory genetic testing could be conducted for highly efficient PGx implementation. Herein we demonstrate that it is regulatorily and technically feasible to implement PGx by identifying suspected carriers of actionable genotypes within an institutional genetics data repository and conduct confirmatory PGx testing immediately prior to that patient receiving the PGx-relevant drug, using a case study of DPYD testing prior to fluoropyrimidine chemotherapy. In two years since launching this program, ~3,000 suspected DPYD carriers have been passively monitored and one confirmed DPYD carrier was prevented from receiving unacceptably toxic fluoropyrimidine treatment, for minimal cost and effort. Now that we have demonstrated the feasibility of this strategy, we plan to transition to PGx panel testing and expand implementation to other genes and drugs for which the evidence of clinical benefit of PGx-informed treatment is high but PGx testing is not generally conducted. This highly efficient implementation process will maximize the clinical benefits of testing and could be explored at other institutions that have research-only genetic data repositories to expand the number of patients who benefit from PGx-informed treatment while we continue to work toward wide-scale adoption of PGx testing and implementation.

PMID:37163252 | DOI:10.1002/cpt.2936

J Oral Rehabil. 2023 May 10. doi: 10.1111/joor.13490. Online ahead of print.

ABSTRACT

BACKGROUND: This study investigated whether Pressure Release Technique (PRT) is effective for reducing pain in people with chronic myofascial Temporomandibular Disorders (TMD).

METHODS: A single-blinded randomized parallel-group trial, with 3 months follow-up was conducted. A total of seventy-two patients were randomly allocated to receive PRT or sham PRT. Primary outcome was pain assessed with a Visual Analogue Scale (VAS). Secondary outcomes included Pressure Pain Thresholds (PPTs), Range of Opening of the Mouth (ROM), Neck Disability Index (NDI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK-11), State-Trait Anxiety Index (STAI) and State-Trait Depression Index (ST-DEP). All parameters were assessed at baseline, at the end of the treatment and at 3 months follow-up. Statistical analysis was performed by ANOVA.

RESULTS: There were significant main effects of time, group and interaction between time and group (F ≥ 21.92; P < .001) on VAS pain. Post-hoc tests showed a significant reduction in VAS pain scores in the PRT group (≥ 31.9%; P < .001). Effect sizes were moderate in the PRT group at all follow-up periods (≥ 1.25 Cohen´s d). Also, there were significant effects of time in secondary outcomes (F ≥ 9.65; P < .001), and there were also interactions between time and group (F ≥ 3.82; P < .002) with better effects in the PRT group.

CONCLUSIONS: The inclusion of PRT to conventional management with occlusal splints and self-care management appears to be effective to improve self-reported levels of pain in patients with chronic myofascial TMD pain. Retrospectively registered (ClinicalTrials.gov: NCT03619889).

PMID:37163204 | DOI:10.1111/joor.13490

J Palliat Med. 2023 May 10. doi: 10.1089/jpm.2022.0567. Online ahead of print.

ABSTRACT

Background: Death in hospital rather than at home is becoming more prevalent, even among terminally ill patients receiving home-based care. Identifying trends in places of death is crucial to care policy, especially for aging populations as in Taiwan. Aim: To identify changes in the places of natural death of Taiwanese individuals for various causes of death. Design: A population-based observational study was conducted. Setting: Anonymous data for the period 2000-2020 from the Death Database of Taiwan’s National Center for Health Statistics Data were obtained and analyzed. Results: In 2000, 60.1% of natural deaths occurred in the home, whereas in 2020, this percentage was only 36.8%; conversely, the percentage of deaths in hospital increased from 34.4% in 2000 to 56.1% in 2020. Deaths in a nursing home or long-term care facility were found to account for only 3.8% of all natural deaths in 2020. Dementia was the cause of death for which the proportion of institutional deaths was highest, although this proportion was <10% for most years. We applied the joinpoint regression model to estimate trend changes in places of death. During the study period, the places of death in Taiwan changed significantly, the average annual percent changes for hospital deaths over the 21-year period was 2.54% (confidence interval [CI]: 2.04 to 3.03), and for home deaths was -2.69% (CI: -3.26 to -2.13). Conclusions: The detailed findings of this national study can offer insight into potential future clinical burdens and lead to better health policy decisions for Taiwan.

PMID:37163202 | DOI:10.1089/jpm.2022.0567

J Multidiscip Healthc. 2023 May 3;16:1239-1248. doi: 10.2147/JMDH.S401601. eCollection 2023.

ABSTRACT

PURPOSE: The majority of women with ovarian cancer are diagnosed in late stages. Most women do have symptoms prior to diagnosis, sometimes several months before the diagnosis. The aim of this study was to evaluate the timeline from the first presentation of symptoms to a physician until there is a reasonable suspicion of cancer, among women diagnosed with advanced stage ovarian cancer. We wanted to investigate which symptoms were the most common and whether there are other factors affecting the time interval before the suspicion of cancer was confirmed.

PATIENTS AND METHODS: This was a retrospective population-based cohort study of women diagnosed with advanced ovarian cancer between January 1, 2017 and December 31, 2019 who were referred to Skane University Hospital Lund, Sweden. Data were collected from electronic medical records at Skane University Hospital. The time interval was recorded as the time from first physician consultation with predefined symptoms to the date when there was a reasonable suspicion of ovarian cancer. Data processing and statistical analysis were performed with the statistical software R.

RESULTS: Among the 249 patients included in this study, the median time interval from the first consultation to the reasonable suspicion of cancer was 24 days. The first consultation in specialized care had a 70% decrease in delay compared to primary care. Emergency consultations had a 52.2% decrease in time delay compared to planned consultations. Older age was associated with an increase in the geometric mean by 54.7%, comparing the first to the third quartile. The most common symptom was abdominal pain.

CONCLUSION: The length of time interval from first presentation with symptoms relating to ovarian cancer to reasonable suspicion of cancer was associated with whether the consultation was in primary or specialized care, emergency or planned visit and the patient’s age.

PMID:37163196 | PMC:PMC10164381 | DOI:10.2147/JMDH.S401601

Int J Womens Health. 2023 May 3;15:665-677. doi: 10.2147/IJWH.S379749. eCollection 2023.

ABSTRACT

PURPOSE: Maternal mortality is one problem that still affects countries like Indonesia and others globally. The World Health Organization (WHO) notes that Southeast Asian countries have a high MMR. Indonesia’s maternal mortality ranks third highest in Southeast Asia, with a 177 maternal mortality rate per 100,000 live births in 2017. In 2018, the maternal mortality rate reached 91.45 per 100,000 live births. Pregnant women’s deaths can be caused inadequate medical care due to how frequently they seek treatment. This study intends to identify and analyze how knowledge, education, and myths affect pregnant women’s attitudes toward seeking health services.

MATERIALS AND METHODS: The study involved 175 pregnant and postpartum women who visited 10 health public centers in two cities in East Java by accidental sampling. Data regarding intrapersonal, interpersonal, and local wisdom were collected through surveys with structured instruments and in-depth interviews. Data statistics used pathway analysis with a p-value of >0.05.

RESULTS: Intrapersonal, interpersonal, and local wisdom variables have a significant direct or indirect effect on utilizing health services. Knowledge was the variable with the greatest influence (t-value, 27.96).

CONCLUSION: Myth and culture as local wisdom and intrapersonal factors significantly affect the pattern of utilizing health services.

PMID:37163191 | PMC:PMC10164391 | DOI:10.2147/IJWH.S379749

HIV AIDS (Auckl). 2023 May 3;15:225-234. doi: 10.2147/HIV.S409152. eCollection 2023.

ABSTRACT

BACKGROUND: Human immunodeficiency virus (HIV) testing coverage among men remains low in Ethiopia; the problem of limited HIV testing coverage is worst in rural areas. Therefore, this study aims to identify factors associated with HIV testing uptake among rural men in Ethiopia.

METHODS: Data from 10,187 rural men was extracted from the 2016 Ethiopian Demography and Health Survey. All analyses were performed using the complex sample analysis procedure to account for the multistage sampling. Bivariable and multivariable regression analyses were performed to identify factors associated with HIV testing uptake. Statistical significance was defined as a 95% Confidence Interval (CI) with a p-value of less than 0.05.

RESULTS: Overall, only 40.3% of rural men have ever been tested for HIV. Being aged 31-44 years (Adjusted Odds Ratio (AOR) =1.12, 95% CI [1.01-1.42]), living in developed regions (AOR=1.43, 95% CI [1.09-1.88]), engaging in non-agricultural activities (AOR = 1.27, 95% CI [1.05-1.52]), being Muslim (AOR = 2.07; 95% CI [1.67-2.67]), having comprehensive knowledge about HIV (AOR =1.31, 95% CI [1.12-1.54]), being from a medium (AOR = 0.56, 95% CI [0.47-0.93]) and rich (AOR = 0.80, 95% CI [0.56-0.80]) households, attending primary (AOR = 0.21, 95% CI [0.16-0.28]) and secondary (AOR = 0.35, 95% CI [0.25-0.35]) school, having their first sexual experience at the age of 17 or younger (AOR = 0.26, 95% CI [0.19-0.93]), having discriminatory attitudes towards HIV patients (AOR = 0.67, 95% CI: 0.47-0.93) and having no health insurance coverage (AOR = 0.54, 95% CI [0.42-0.69]) were significantly associated with HIV testing uptake.

CONCLUSION: HIV testing uptake among rural men was low. Strengthening awareness programmes on HIV and HIV testing, integrating HIV testing with all other healthcare, strengthening partner accompany and HIV testing during pregnancy and delivery, and providing home-based HIV testing may increase HIV testing uptake.

PMID:37163176 | PMC:PMC10164390 | DOI:10.2147/HIV.S409152

Digit Health. 2023 May 4;9:20552076231173306. doi: 10.1177/20552076231173306. eCollection 2023 Jan-Dec.

ABSTRACT

BACKGROUND: Unintended pregnancy has been a major public health and reproductive health issue imposing a great adverse consequence on the mother and child. However, estimates of unintended pregnancy through the appropriate model are lacking. This study is aimed at modeling and assessing the extent of variation and factors associated with unintended pregnancy among women in Ethiopia.

METHODS: A cross-sectional study was conducted based on 2016 Ethiopian Demographic and Health Survey data related to the reproductive health of 1122 currently pregnant women and a multilevel modeling approach was used.

RESULTS: The proportion of unintended current pregnancies was 20.1%. According to random intercept with a fixed slope model, women who had 1 to 3 living children and those who had 4 and above were more likely to be unintended (OR = 3.54, 95% CI: 1.985-6.332) and (OR = 5.47, 95% CI: 2.67-11.227), respectively, compared to women with no living children. Also, married women were less likely to be unintended (OR = 0.14, 95% CI: 0.065-0.304) compared to unmarried women. In addition, women having work were more likely to be unintended (OR = 1.56, 95% CI: 1.079-2.255). Furthermore, women who intend to use contraceptive methods were less likely to be unintended (OR = 0.54, 95% CI: 0.362-0.796) compared to women who do not intend.

CONCLUSION: The number of living children, current marital status, the intention of contraceptive use, and respondents’ working status were found to have a significant effect. Giving attention to regional variations and intention of contraceptive use is important to reduce unintended current pregnancies in Ethiopia.

PMID:37163173 | PMC:PMC10164261 | DOI:10.1177/20552076231173306

Digit Health. 2023 May 4;9:20552076231173528. doi: 10.1177/20552076231173528. eCollection 2023 Jan-Dec.

ABSTRACT

OBJECTIVE: This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress.

METHODS: Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults (N = 3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use.

RESULTS: Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons.

CONCLUSIONS: This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources.

PMID:37163172 | PMC:PMC10164262 | DOI:10.1177/20552076231173528

Therap Adv Gastroenterol. 2023 May 5;16:17562848231170484. doi: 10.1177/17562848231170484. eCollection 2023.

ABSTRACT

BACKGROUND: With a 15% incidence, KRAS is one of the most common mutations in biliary tract cancer (BTC) and is a poor prognostic factor. Immune checkpoint inhibitors (ICIs) as salvage therapy have modest activity in BTC.

OBJECTIVES: There are limited data on the efficacy of ICIs according to KRAS mutation in BTC. We evaluated the efficacy of ICIs in BTC patients with or without KRAS mutations.

DESIGN: Retrospective observational study.

METHODS: We conducted molecular profiling in BTC patients who received ICIs as salvage therapy. The expression of programmed death ligand 1 (PD-L1) on tumor cells was assessed using immunohistochemistry. The TruSight^TM Oncology 500 assay from Illumina was used as a cancer panel. We analyzed overall survival (OS) and progression-free survival (PFS) of ICI in BTC patients according to KRAS mutation and PD-L1 expression.

RESULTS: A total of 62 patients were included in this analysis. The median age was 68.0 years; 47 patients (75.8%) received pembrolizumab and 15 (24.2%) received nivolumab as salvage therapy. All patients received gemcitabine plus cisplatin as the frontline therapy, and 53.2% received fluoropyrimidine plus oxaliplatin (FOLFOX) before ICI. The median number of lines of prior chemotherapy was 2.5. The KRAS mutation was found in 13 patients (19.1%), and 28 patients (45.2%) showed 1% or more of tumor cells out of visible tumor cells positive for PD-L1. There was no statistical correlation between KRAS mutation and PD-L1 expression. The median OS and PFS with ICI were 5.6 [interquartile range (IQR): 3.3-8.0] and 3.8 (IQR: 3.0-4.5) months, respectively. There were no statistically significant differences in PFS with ICIs according to KRAS mutation (mutant type versus wild type) and PD-L1 expression (positive versus negative). In subgroup analysis, patients with both KRAS mutation and PD-L1 positivity had longer PFS compared with patients with KRAS mutation and PD-L1 negativity (10.1 versus 2.6 months, p = 0.047). This finding was not shown in patients with wild-type KRAS.

CONCLUSION: Our analysis suggested that PD-L1 expression might be a useful biomarker for ICIs in BTC patients with KRAS mutation but not in those with wild-type KRAS.

PMID:37163165 | PMC:PMC10164250 | DOI:10.1177/17562848231170484