Category: Nevin Manimala

JAMA Netw Open. 2022 Oct 3;5(10):e2236298. doi: 10.1001/jamanetworkopen.2022.36298.

ABSTRACT

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention-a key indicator of care quality.

OBJECTIVES: To compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19-related policy changes.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19-related changes; prior to COVID-19-related changes).

EXPOSURES: Patient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person).

MAIN OUTCOMES AND MEASURES: Treatment modality; 90-day retention.

RESULTS: Among 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non-service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non-service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19-related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19-related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.

PMID:36223118 | DOI:10.1001/jamanetworkopen.2022.36298

Leuk Lymphoma. 2022 Oct 12:1-10. doi: 10.1080/10428194.2022.2131415. Online ahead of print.

ABSTRACT

Several studies have shown a strong predictive value for pretreatment [¹⁸F]FDG-PET/CT metabolic parameters in different lymphoma subtypes. However, few publications exist concerning the role of metabolic parameters in mantle cell lymphoma (MCL). We retrospectively investigated the prognostic value of baseline metabolic tumor volume (MTV) and lesion dissemination in untreated MCL. We compared it to currently used prognostic factors such as stage, mantle cell lymphoma international prognostic index (MIPI) and KI-67. We report that a higher baseline MTV is a risk factor for worse overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS) in univariate analysis. In multivariate analysis, MTV was significantly associated with DSS, but not with OS and PFS. We found no correlation between lesion dissemination and outcome. The MIPI score remains the strongest predictor of outcome. These results show that MTV is an important prognostic tool and can improve patient risk stratification at staging of untreated MCL.

PMID:36223113 | DOI:10.1080/10428194.2022.2131415

Multivariate Behav Res. 2022 Oct 12:1-16. doi: 10.1080/00273171.2022.2119928. Online ahead of print.

ABSTRACT

Statistical mediation analysis is used in the social sciences and public health to uncover potential mechanisms, known as mediators, by which a treatment led to a change in an outcome. Recently, the estimation of the treatment-by-mediator interaction (i.e., the XM interaction) has been shown to play a pivotal role in understanding the equivalence between the traditional mediation effects in linear models and the causal mediation effects in the potential outcomes framework. However, there is limited guidance on how to estimate the XM interaction when the mediator is latent. In this article, we discuss eight methods to accommodate latent XM interactions in statistical mediation analysis, which fall in two categories: using structural models (e.g., latent moderated structural equations, Bayesian mediation, unconstrained product indicator method, multiple-group models) or scoring the mediator prior to estimating the XM interaction (e.g., summed scores and factor scores, with and without attenuation correction). Simulation results suggest that finite-sample bias is low, type 1 error rates and coverage of percentile bootstrap confidence intervals and Bayesian credible intervals are close to the nominal values, and statistical power is similar across approaches. The methods are demonstrated with an applied example, syntax is provided for their implementation, and general considerations are discussed.

PMID:36223100 | DOI:10.1080/00273171.2022.2119928

Dermatol Ther (Heidelb). 2022 Oct 12. doi: 10.1007/s13555-022-00824-9. Online ahead of print.

ABSTRACT

INTRODUCTION: To date, there have been no head-to-head clinical studies comparing calcipotriol 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) aerosol foam and halobetasol propionate 0.01% plus tazarotene 0.045% (HP/Taz) lotion for the treatment of plaque psoriasis. However, the efficacy of 4 weeks of Cal/BD foam and 8 weeks of HP/Taz lotion has been compared using a matching-adjusted indirect comparison (MAIC) approach. Here, we compare the efficacy and safety of Cal/BD foam and HP/Taz lotion for up to 52 weeks.

METHODS: An unanchored MAIC was conducted using individual patient data from the PSO-LONG Cal/BD foam trial and a 52-week, open-label phase 3 study of HP/Taz lotion (NCT02462083). Key outcomes of interest were Physician’s Global Assessment (PGA) success (PGA 0/1 with ≥ 2-point improvement) after 4 or 8 weeks of open-label therapy; the proportion of patients who had body surface area affected (BSA) ≤ 3 after open-label therapy who maintained BSA ≤ 3 to week 52; and adverse events (AEs).

RESULTS: After matching, patients were statistically significantly more likely to have PGA success after 4 weeks of Cal/BD foam than after 8 weeks of HP/Taz lotion (84.5% versus 54.4%; p < 0.01). At week 52, 92.5% and 92.4% of patients receiving proactive and reactive Cal/BD foam, respectively, maintained BSA ≤ 3, compared with 49.3% of those treated with HP/Taz lotion (both p < 0.01). Treatment-related AEs, AEs leading to withdrawal, and AEs associated with drug application (dermatitis, application site pain, and pruritus) were significantly rarer with Cal/BD foam than with HP/Taz lotion (all p < 0.01).

CONCLUSIONS: Cal/BD aerosol foam demonstrated significantly greater efficacy than HP/Taz lotion, and had a more favorable safety profile, compared with HP/Taz lotion, for up to 52 weeks. Proactive Cal/BD foam maintenance therapy and reactive use of Cal/BD foam following relapse both had significant advantages over HP/Taz lotion.

PMID:36223060 | DOI:10.1007/s13555-022-00824-9

Ophthalmol Ther. 2022 Oct 12. doi: 10.1007/s40123-022-00580-1. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to illustrate the efficacy of the combination of lens extraction, trabeculectomy, and anterior vitrectomy in patients with secondary angle-closure glaucoma (ACG) with autosomal recessive bestrophinopathy or Best vitelliform macular dystrophy.

METHODS: This is a retrospective self-controlled case series study. Five patients undergoing a single trabeculectomy in one eye and triple surgery in the other eye were enrolled. All patients underwent a complete ophthalmic examination that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), ultrasound biomicroscopy, and static gonioscopy. Multimodal fundus imaging was performed, including color fundus photography, fundus autofluorescence, and optical coherence tomography. Genetic testing was also analyzed.

RESULTS: Among the 10 eyes, the mean IOP was 31.4 ± 4.7 mmHg before surgery. The mean axial length (AL) was 21.53 mm and the anterior chamber depth (ACD) was 2.31 mm. There were no statistically significant differences in preoperative IOP, BCVA, ACD, and AL between the two groups (all P > 0.05). The mean follow-up time was 64.0 months. All five eyes with a single trabeculectomy developed malignant glaucoma (MG). No complications were found in the other five eyes with triple surgery, and the anterior chamber was deepened and stable after surgery until the last visit. The mean IOP at the last visit was normalized to 16 mmHg without using any medications.

CONCLUSIONS: Triple surgery is superior to single trabeculectomy for patients with ACG and BEST1 mutation, effectively bypassing MG complications. The vitreous may play a vital role in the mechanism of ACG in those patients and the high incidence of MG after filtering surgery.

PMID:36223057 | DOI:10.1007/s40123-022-00580-1

Environ Sci Pollut Res Int. 2022 Oct 12. doi: 10.1007/s11356-022-23481-z. Online ahead of print.

ABSTRACT

In the present study, the performance of facile hybrid sequential chemical treatments of titanomagnetite concentrate (TC), alkaline leaching, and sodium dodecyl sulfate (SDS) modification has been evaluated for the removal of crystal violet (CV), malachite green (MG), and methylene blue (MB) cationic dyes. The physical and chemical properties of samples were characterized using scanning electron microscopy (SEM), energy dispersive X-ray (EDX), N₂ adsorption-desorption, X-ray diffraction (XRD), X-ray fluorescence spectroscopy (XRF), and Fourier transform infrared spectroscopy (FTIR) analyses. Moreover, dye removal in the batch system was investigated by evaluating adsorbent dosage, contact time, initial dye concentration, pH of the solution, temperature, electrolyte concentration, adsorption isotherm, kinetic, and thermodynamic. The results showed that the maximum adsorption capacity was obtained at SDS concentration of 6 mM, NaOH concentration of 9 M, the temperature of 160 °C, solid/liquid ratio of 4 g/100 mL, and the process duration of 24 h. In the alkaline leaching process, forming the Na₂TiO₃ phase with sharp and high energy points can be improved the adsorption properties. Accordingly, the adsorption capacity and removal efficiency attained 19.84, 18.64, and 19.66 mg/g and 99.21, 93.24, and 98.31% for CV, MG, and MB, respectively. Furthermore, the dye removal followed pseudo-second-order (R² = 0.9990) and Freundlich (R² = 0.9970) models. The evaluation of thermodynamic parameters indicated the endothermic (∆H° = 110.91 J/mol) and spontaneous nature (ΔG˚ < 0) of the adsorption process. This study concluded that the modified TC had a potential ability for application in textile wastewater treatment.

PMID:36223025 | DOI:10.1007/s11356-022-23481-z

Behav Res Methods. 2022 Oct 12. doi: 10.3758/s13428-022-01971-9. Online ahead of print.

ABSTRACT

Currently, the design standards for single-case experimental designs (SCEDs) are based on validity considerations as prescribed by the What Works Clearinghouse. However, there is a need for design considerations such as power based on statistical analyses. We compute and derive power using computations for (AB)^k designs with multiple cases which are common in SCEDs. Our computations show that effect size has the maximum impact on power followed by the number of subjects and then the number of phase reversals. An effect size of 0.75 or higher, at least one set of phase reversals (i.e., where k > 1), and at least three subjects showed high power. The latter two conditions agree with current standards about either having at least an ABAB design or a multiple baseline design with three subjects to meet design standards. An effect size of 0.75 or higher is not uncommon in SCEDs either. Autocorrelations, the number of time-points per phase, and intraclass correlations had a smaller but non-negligible impact on power. In sum, power analyses in the present study show that conditions to meet power requirements are not unreasonable in SCEDs. The software code to compute power is available on GitHub for the use of the reader.

PMID:36223007 | DOI:10.3758/s13428-022-01971-9

Support Care Cancer. 2022 Oct 12. doi: 10.1007/s00520-022-07371-1. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer is one of the most prevalent diseases and is recognized as a global problem that is currently showing a growing trend. Cancer is one of the most stressful circumstances that a person may experience. Given how the mental state of patients with depression and anxiety may have a negative impact on their experience with cancer, this study was conducted with the aim to investigate the prevalence of anxiety and depression in cancer patients in Iran.

METHODS: This study was conducted using a systematic review method and based on the guideline Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020). The studies used were searched for via databases, Scopus, Web of Science (WOS), Google Scholar, SID, Magiran, and using keywords related to anxiety, depression, and cancer. After extracting the required data, statistical analysis was performed based on the random model and using the second version of Comprehensive Meta-Analysis Software.

RESULTS: In a review of 24 studies with a sample size of 3225 people, the overall prevalence of depression in cancer patients in Iran was reported to be 50.1% (95% CI: 40.6-59.6). Additionally, in a review of 15 studies with a sample size of 2009, the overall prevalence of anxiety in cancer patients in Iran was reported to be 40.9% (95% CI: 30.9-51.6). The highest reported prevalence of depression in cancer patients in Iran according to the Beck questionnaire is 64.6 (95% CI: 48.2-78.1). Specifically, the highest prevalence of depression was reported in patients with breast cancer with a prevalence of 66 (95% CI: 50.9-78.4). The highest prevalence of anxiety in patients with cancer in Iran according to the Depression, Anxiety, and Stress Scale was 49.2 (95% CI: 18.9-80.1). Comparatively, the highest prevalence of anxiety in patients with breast cancer was reported to be 53.2 (95% CI: 25.8-78.7).

CONCLUSION: The prevalence of depression and anxiety among cancer patients in Iran, in particular patients with breast cancer, is significantly higher than in other parts of the world. The prevalence found in our study was even higher than the reported number by studies that have examined the disorder globally. Therefore, it is of great urgency for health system policymakers to work to improve the current situation.

PMID:36222976 | DOI:10.1007/s00520-022-07371-1

J Urban Health. 2022 Oct 12. doi: 10.1007/s11524-022-00687-7. Online ahead of print.

ABSTRACT

Food environments of urban informal settlements are likely drivers of dietary intake among residents of such settlements. Yet, few attempts have been made to describe them. The objective of this study was to characterize the food environment of a densely-populated informal settlement in Nairobi, Kenya according to the obesogenic properties and spatial distribution of its food vendors. In July-August 2019, we identified food vendors in the settlement and classified them into obesogenic risk categories based on the types of food that they sold. We calculated descriptive statistics and assessed clustering according to obesogenic risk using Ripley’s K function. Foods most commonly sold among the 456 vendors in the analytic sample were sweets/confectionary (29% of vendors), raw vegetables (28%), fried starches (23%), and fruits (21%). Forty-four percent of vendors were classified as low-risk, protective; 34% as high-risk, non-protective; 16% as low-risk, non-protective; and 6% as high-risk, protective. The mean distance (95% confidence interval) to the nearest vendor of the same obesogenic risk category was 26 m (21, 31) for vendors in the low-risk, protective group; 29 m (25, 33) in the high-risk, non-protective group; 114 m (88, 139) in the high-risk, protective group; and 43 m (30, 56) in the low-risk, non-protective group. Clustering was significant for all obesogenic risk groups except for the high-risk, protective. Our findings indicate a duality of obesogenic and anti-obesogenic foods in this environment. Clustering of obesogenic foods highlights the need for local officials to take action to increase access to health-promoting foods throughout informal settlements.

PMID:36222974 | DOI:10.1007/s11524-022-00687-7

J Neural Transm (Vienna). 2022 Oct 12. doi: 10.1007/s00702-022-02547-9. Online ahead of print.

ABSTRACT

Prior studies indicate more severe brainstem cholinergic deficits in Progressive Supranuclear Palsy (PSP) compared to Parkinson’s disease (PD), but the extent and topography of subcortical deficits remains poorly understood. The objective of this study is to investigate differential cholinergic systems changes in progressive supranuclear palsy (PSP, n = 8) versus Parkinson’s disease (PD, n = 107) and older controls (n = 19) using vesicular acetylcholine transporter [¹⁸F]-fluoroethoxybenzovesamicol (FEOBV) positron emission tomography (PET). A whole-brain voxel-based PET analysis using Statistical Parametric Mapping (SPM) software (SPM12) for inter-group comparisons using parametric [¹⁸F]-FEOBV DVR images. Voxel-based analyses showed lower FEOBV binding in the tectum, metathalamus, epithalamus, pulvinar, bilateral frontal opercula, anterior insulae, superior temporal pole, anterior cingulum, some striatal subregions, lower brainstem, and cerebellum in PSP versus PD (p < 0.05; false discovery rate-corrected). More severe and diffuse reductions were present in PSP vs controls. Higher frequency of midbrain cholinergic losses was seen in PSP compared to the PD participants using 5th percentile normative cut-off values (χ² = 4.12, p < 0.05). When compared to PD, these findings suggested disease-specific cholinergic vulnerability in the tectum, striatal cholinergic interneurons, and projections from the pedunculopontine nucleus, medial vestibular nucleus, and the cholinergic forebrain in PSP.

PMID:36222971 | DOI:10.1007/s00702-022-02547-9