Category: Nevin Manimala

JAMA Netw Open. 2023 May 1;6(5):e2314135. doi: 10.1001/jamanetworkopen.2023.14135.

ABSTRACT

IMPORTANCE: Co-occurring physical and psychological symptoms during childhood and early adolescence may increase risk of symptom persistence into adulthood.

OBJECTIVE: To describe co-occurring pain, psychological, and sleep disturbance symptom (pain-PSS) trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a secondary analysis of longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study, collected between 2016 and 2022 at 21 research sites across the US. Participants included children with 2 to 4 complete annual symptom assessments. Data were analyzed from November 2022 to March 2023.

MAIN OUTCOMES AND MEASURES: Four-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain-PSS scores, including depression and anxiety, were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Nonroutine medical care and mental health care utilization were measured using medical history and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) items.

RESULTS: A total of 11 473 children (6018 [52.5%] male; mean [SD] age at baseline, 9.91 [0.63] years) were included in analyses. Four no pain-PSS and 5 pain-PSS trajectories were supported with good or excellent model fit (predicted probabilities, 0.87-0.96). Most children (9327 [81.3%]) had asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children (2146 [18.7%]) had moderate to high co-occurring symptom trajectories that persisted or worsened. Compared with White children, there was a lower relative risk of having moderate to high co-occurring symptom trajectories among Black children (adjusted relative risk ratio [aRRR] range, 0.15-0.38), Hispanic children (aRRR range, 0.58-0.67), and children who identified as another race (including American Indian, Asian, Native Hawaiian, and other Pacific Islader; aRRR range, 0.43-0.59). Less than half of children with moderate to high co-occurring symptom trajectories used nonroutine health care, despite higher utilization compared with asymptomatic children (nonroutine medical care: adjusted odds ratio [aOR], 2.43 [95% CI, 1.97-2.99]; mental health services: aOR, 26.84 [95% CI, 17.89-40.29]). Black children were less likely to report nonroutine medical care (aOR, 0.61 [95% CI, 0.52-0.71]) or mental health care (aOR, 0.68 [95% CI, 0.54-0.87]) than White children, while Hispanic children were less likely to have used mental health care (aOR, 0.59 [95% CI, 0.47-0.73]) than non-Hispanic children. Lower household income was associated with lower odds of nonroutine medical care (aOR, 0.87 [95% CI, 0.77-0.99]) but not mental health care.

CONCLUSIONS AND RELEVANCE: These findings suggest there is a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.

PMID:37200032 | DOI:10.1001/jamanetworkopen.2023.14135

JAMA Oncol. 2023 May 18. doi: 10.1001/jamaoncol.2023.0990. Online ahead of print.

ABSTRACT

IMPORTANCE: O6-methylguanine-DNA methyltransferase (MGMT [OMIM 156569]) promoter methylation (mMGMT) is predictive of response to alkylating chemotherapy for glioblastomas and is routinely used to guide treatment decisions. However, the utility of MGMT promoter status for low-grade and anaplastic gliomas remains unclear due to molecular heterogeneity and the lack of sufficiently large data sets.

OBJECTIVE: To evaluate the association of mMGMT for low-grade and anaplastic gliomas with chemotherapy response.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study aggregated grade II and III primary glioma data from 3 prospective cohort studies with patient data collected from August 13, 1995, to August 3, 2022, comprising 411 patients: MSK-IMPACT, EORTC (European Organization of Research and Treatment of Cancer) 26951, and Columbia University. Statistical analysis was performed from April 2022 to January 2023.

EXPOSURE: MGMT promoter methylation status.

MAIN OUTCOMES AND MEASURES: Multivariable Cox proportional hazards regression modeling was used to assess the association of mMGMT status with progression-free survival (PFS) and overall survival (OS) after adjusting for age, sex, molecular class, grade, chemotherapy, and radiotherapy. Subgroups were stratified by treatment status and World Health Organization 2016 molecular classification.

RESULTS: A total of 411 patients (mean [SD] age, 44.1 [14.5] years; 283 men [58%]) met the inclusion criteria, 288 of whom received alkylating chemotherapy. MGMT promoter methylation was observed in 42% of isocitrate dehydrogenase (IDH)-wild-type gliomas (56 of 135), 53% of IDH-mutant and non-codeleted gliomas (79 of 149), and 74% of IDH-mutant and 1p/19q-codeleted gliomas (94 of 127). Among patients who received chemotherapy, mMGMT was associated with improved PFS (median, 68 months [95% CI, 54-132 months] vs 30 months [95% CI, 15-54 months]; log-rank P < .001; adjusted hazard ratio [aHR] for unmethylated MGMT, 1.95 [95% CI, 1.39-2.75]; P < .001) and OS (median, 137 months [95% CI, 104 months to not reached] vs 61 months [95% CI, 47-97 months]; log-rank P < .001; aHR, 1.65 [95% CI, 1.11-2.46]; P = .01). After adjusting for clinical factors, MGMT promoter status was associated with chemotherapy response in IDH-wild-type gliomas (aHR for PFS, 2.15 [95% CI, 1.26-3.66]; P = .005; aHR for OS, 1.69 [95% CI, 0.98-2.91]; P = .06) and IDH-mutant and codeleted gliomas (aHR for PFS, 2.99 [95% CI, 1.44-6.21]; P = .003; aHR for OS, 4.21 [95% CI, 1.25-14.2]; P = .02), but not IDH-mutant and non-codeleted gliomas (aHR for PFS, 1.19 [95% CI, 0.67-2.12]; P = .56; aHR for OS, 1.07 [95% CI, 0.54-2.12]; P = .85). Among patients who did not receive chemotherapy, mMGMT status was not associated with PFS or OS.

CONCLUSIONS AND RELEVANCE: This study suggests that mMGMT is associated with response to alkylating chemotherapy for low-grade and anaplastic gliomas and may be considered as a stratification factor in future clinical trials of patients with IDH-wild-type and IDH-mutant and codeleted tumors.

PMID:37200021 | DOI:10.1001/jamaoncol.2023.0990

JAMA Otolaryngol Head Neck Surg. 2023 May 18. doi: 10.1001/jamaoto.2023.0948. Online ahead of print.

ABSTRACT

IMPORTANCE: Allostatic load, the cumulative strain that results from the chronic stress response, is associated with poor health outcomes. Increased cognitive load and impaired communication associated with hearing loss could potentially be associated with higher allostatic load, but few studies to date have quantified this association.

OBJECTIVE: To investigate if audiometric hearing loss is associated with allostatic load and evaluate if the association varies by demographic factors.

DESIGN, SETTING, PARTICIPANTS: This cross-sectional survey used nationally representative data from the National Health and Nutrition Examination Survey. Audiometric testing was conducted from 2003 to 2004 (ages 20-69 years) and 2009 to 2010 (70 years or older). The study was restricted to participants aged 50 years or older, and the analysis was stratified based on cycle. The data were analyzed between October 2021 and October 2022.

EXPOSURE: A 4-frequency (0.5-4.0 kHz) pure tone average was calculated in the better-hearing ear and modeled continuously and categorically (<25 dB hearing level [dB HL], no hearing loss; 26-40 dB HL, mild hearing loss; ≥41 dB HL, moderate or greater hearing loss).

MAIN OUTCOME AND MEASURES: Allostatic load score (ALS) was defined using laboratory measurements of 8 biomarkers (systolic/diastolic blood pressure, body mass index [calculated as weight in kilograms divided by height in meters squared], and total serum and high-density lipoprotein cholesterol, glycohemoglobin, albumin, and C-reactive protein levels). Each biomarker was assigned a point if it was in the highest risk quartile based on statistical distribution and then summed to yield the ALS (range, 0-8). Linear regression models adjusted for demographic and clinical covariates. Sensitivity analysis included using clinical cut points for ALS and subgroup stratification.

RESULTS: In 1412 participants (mean [SD] age, 59.7 [5.9] years; 293 women [51.9%]; 130 [23.0%] Hispanic, 89 [15.8%] non-Hispanic Black, and 318 [55.3%] non-Hispanic White individuals), a modest association was suggested between hearing loss and ALS (ages 50-69 years: β = 0.19 [95% CI, 0.02-0.36] per 10 dB HL; 70 years or older: β = 0.10 [95% CI, 0.02-0.18] per 10 dB HL) among non-hearing aid users. Results were not clearly reflected in the sensitivity analysis with clinical cut points for ALS or modeling hearing loss categorically. Sex-based stratifications identified a stronger association among male individuals (men 70 years or older: β = 0.22 [95% CI, 0.12-0.32] per 10 dB HL; women: β = 0.08 [95% CI, -0.04 to 0.20] per 10 dB HL).

CONCLUSION AND RELEVANCE: The study findings did not clearly support an association between hearing loss and ALS. While hearing loss has been shown to be associated with increased risk for numerous health comorbidities, its association with the chronic stress response and allostasis may be less than that of other health conditions.

PMID:37200015 | DOI:10.1001/jamaoto.2023.0948

Ear Nose Throat J. 2023 May 18:1455613231170952. doi: 10.1177/01455613231170952. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate the effects of titanium partial ossicular replacement prosthesis (PORP) and conchal cartilage for ossiculoplasty on hearing results in single-stage canal wall down (CWD) mastoidectomy surgery with type II tympanoplasty in patients with cholesteatoma.

METHODS: The patients were performed surgeries for the first time by a senior otosurgeon from 2009 to 2022 and were performed CWD mastoidectomy with type II tympanoplasty in one stage were enrolled. Patients who could not be followed up were excluded. Titanium PORP or conchal cartilage was used for ossiculoplasty. When the stapes head was intact, a cartilage 1.2-1.5 mm thick was attached directly to the stapes; when the head of the stapes was eroded, a 1 mm high PORP and cartilage of .2-.5 mm thick were placed on the stapes simultaneously.

RESULTS: 148 patients were included in the study in total. The titanium PORP and conchal cartilage groups showed no statistically significant differences at 500, 1000, 2000, and 4000 Hz considering the number of decibels of closure of the air-bone gap (ABG) (P > .05) and pure-tone average ABG (PTA-ABG) (P > .05). Meanwhile, the closure of PTA-ABG between the 2 groups showed no statistically significant differences in the overall distribution (P > .05).

CONCLUSIONS: For patients with cholesteatoma and mobile stapes who underwent CWD mastoidectomy with type II tympanoplasty in one stage, either PORP or conchal cartilage is a satisfactory material for ossiculoplasty.

PMID:37200002 | DOI:10.1177/01455613231170952

Euro Surveill. 2023 May;28(20). doi: 10.2807/1560-7917.ES.2023.28.20.2200672.

ABSTRACT

BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide.AimWe aimed to summarise the German AMR situation for clinicians and microbiologists.MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016-2021) and the case fatality rates (2010-2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively.ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886-0.891; p < 0.0001), while vancomycin resistance in Enterococcus faecium (VRE) bloodstream infections increased (OR = 1.18; (95% CI: 1.16-1.21); p < 0.0001) with a pooled proportion of 34.9%. Case fatality rates for MRSA and VRE were higher than for their susceptible strains (OR = 2.29; 95% CI: 1.91-2.75 and 1.69; 95% CI: 1.22-2.33, respectively). Carbapenem resistance in Gram-negative pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter spp. and Escherichia coli) was low to moderate (< 9%), but resistance against third-generation cephalosporins and fluoroquinolones was moderate to high (5-25%). Pseudomonas aeruginosa exhibited high resistance against carbapenems (17.0%; 95% CI: 11.9-22.8), third-generation cephalosporins (10.1%; 95% CI: 6.6-14.2) and fluoroquinolones (24.9%; 95% CI: 19.3-30.9). Statistical heterogeneity was high (I2 > 70%) across studies reporting resistance proportions.ConclusionContinuous efforts in AMR surveillance and infection prevention and control as well as antibiotic stewardship are needed to limit the spread of AMR in Germany.

PMID:37199987 | DOI:10.2807/1560-7917.ES.2023.28.20.2200672

Psychol Trauma. 2023 May 18. doi: 10.1037/tra0001485. Online ahead of print.

ABSTRACT

OBJECTIVE: Contamination concerns are common following sexual victimization and are associated with increased attentional bias and difficulty disengaging from contamination cues. While most survivors of sexual trauma disclose their experience to others, it is unclear whether disclosure increases feelings of contamination or whether, consistent with the fever model of disclosure, existing contamination-related distress increases the amount of content shared during disclosure, indicative of attentional bias toward contamination-inducing aspects of the trauma memory.

METHOD: Accordingly, the current study examined the directionality and relationships between contamination symptoms and content shared during sexual assault disclosure in 106 sexual assault survivors (76.4% women). Forced decision regression with subsequent independence test (RESIT) was used to identify directionality of relationships, and multivariate and linear regressions examined these proposed effects in the presence of assault and demographic characteristics.

RESULTS: More severe contamination symptoms predicted greater sharing of details during sexual assault disclosure yet had no impact on sharing of emotions, cognitions, and beliefs during disclosures. Although RESIT suggested that contrary to other content domains, disclosure of social experiences may directionally predict contamination symptoms, this relationship did not retain statistical significance in a linear regression model.

CONCLUSIONS: Findings support the fever model of disclosure and attentional bias theories regarding contamination-related stimuli, and suggest that survivors experiencing postassault contamination symptoms may be more likely fixate on the contamination-invoking details of the trauma memory when disclosing. Such fixation has the potential to interfere with typical treatment-related processes (e.g., habituation) and should be thoughtfully addressed to maximize treatment gains. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37199983 | DOI:10.1037/tra0001485

J Exp Psychol Gen. 2023 May 18. doi: 10.1037/xge0001413. Online ahead of print.

ABSTRACT

The well-known Mondrian-style images, aside from being aesthetically amusing, also reflect the core principles of human vision in their viewing experience. First, when we see a Mondrian-style image consisting only of a grid and primary colors, we may automatically interpret its causal history such that it was generated by recursively partitioning a blank scene. Second, the image we observe is open to many possible ways of partitioning, and their probabilities of dominating the interpretation can be captured by a probabilistic distribution. Moreover, the causal interpretation of a Mondrian-style image can emerge almost spontaneously, not being tailored to any specific task. Using Mondrian-style images as a case study, we demonstrate the generative nature of human vision by showing that a Bayesian model based upon an image-generation task can support a wide range of visual tasks with little retraining. Our model, learned from human-synthesized Mondrian-style images, could predict human performance in the perceptual complexity ranking, capture the transmission stability when images were iteratively passed among participants, and pass a visual Turing test. Our results collectively show that human vision is causal such that we interpret an image from the angle of how it was generated. The success of generalization with little retraining suggests that generative vision constitutes a type of common sense that supports a wide range of tasks of different natures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37199976 | DOI:10.1037/xge0001413

Cultur Divers Ethnic Minor Psychol. 2023 May 18. doi: 10.1037/cdp0000590. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this article is to introduce a self-report measure of cultural embeddedness for Māori (Māori Cultural Embeddedness Scale [MaCES]), which builds on theoretical and qualitative research on the concept.

METHOD: A total of 548 adults who self-identified as Māori responded to 49 items that were designed to measure aspects of Māori Cultural Values, Beliefs, and Practices. The data were analyzed using confirmatory factor analysis, and invariance was tested through multigroup confirmatory factor analysis.

RESULTS: A total of six items were pruned from the measure for having low loadings on the latent factor, having ambiguous wording, and/or measuring contentious concepts. The remaining 43 items fit the data well when organized by three primary factors (i.e., Values, Beliefs, and Practices), further split into secondary subfactors. We also found that this nuanced subfactor model was invariant to sole/mixed identification as Māori, as well as growing up in urban or rural settings. We found evidence of structural validity for the MaCES, but ongoing validation, including convergent and divergent comparisons to other scales, is required in future work.

CONCLUSIONS: The MaCES is a theoretically derived and statistically sound measure that offers significant research potential for exploring the various ways that embeddedness in Māori culture informs differential outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37199959 | DOI:10.1037/cdp0000590

J Fam Psychol. 2023 May 18. doi: 10.1037/fam0001097. Online ahead of print.

ABSTRACT

This study considered how mothers’ and fathers’ inhibitory control, an aspect of executive functioning (EF) that reflects how well an individual can suppress a dominant response to perform a subdominant response, is associated with observations of their parenting quality when children were 7.5 years old. Furthermore, aspects of the daily home environment may strengthen or undermine parents’ ability to draw on their inhibitory control and exhibit high-quality parenting. Household chaos, including clutter, confusion, and ambient noise, may impair parents’ ability to successfully activate inhibitory control and engage in high-quality parenting. Thus, additional analyses examined whether parents’ perceptions of household chaos moderated associations between inhibitory control and parenting. Data came from a sample of approximately 102 families headed by different-sex parents (n = 99 mothers; n = 90 fathers) of 7.5-year-old children who participated in a study of family development. Findings from multilevel models indicated that inhibitory control predicted greater positive-sensitive parenting in contexts of low household chaos. Associations between inhibitory control and parenting quality were not statistically significant in contexts of average or high household chaos. These findings highlight the importance of considering household chaos and inhibitory control as factors associated with parenting quality for fathers and mothers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37199942 | DOI:10.1037/fam0001097

Personal Disord. 2023 May 18. doi: 10.1037/per0000627. Online ahead of print.

ABSTRACT

Treatment dropout is high among outpatients with borderline personality disorder (BPD) and is associated with myriad negative therapeutic and psychosocial outcomes. Identifying predictors of treatment dropout can inform treatment provision for this population. The present study investigated whether symptom profiles of static and dynamic factors could predict treatment dropout. Treatment-seeking outpatients with BPD (N = 102) completed pre-treatment measures of BPD symptom severity, emotion dysregulation, impulsivity, motivation, self-harm, and attachment style to determine their collective impact on dropout prior to 6 months of treatment. Discriminant function analysis was used to classify group membership (treatment dropout vs. nondropout) but did not produce a statistically significant function. Groups were distinguished by baseline levels of emotion dysregulation with higher dysregulation predicting premature treatment dropout. Clinicians working with outpatients with BPD might benefit from optimizing emotion regulation and distress tolerance strategies earlier in treatment to reduce premature dropout. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:37199933 | DOI:10.1037/per0000627