Category: Nevin Manimala

JAMA Netw Open. 2023 Apr 3;6(4):e236331. doi: 10.1001/jamanetworkopen.2023.6331.

ABSTRACT

IMPORTANCE: Family meals are a formative learning environment that shapes children’s food choices and preferences. As such, they are an ideal setting for efforts to improve children’s nutritional health.

OBJECTIVE: To examine the effect of extending the duration of family meals on the fruit and vegetable intake in children.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used a within-dyad manipulation design and was conducted from November 8, 2016, to May 5, 2017, in a family meal laboratory in Berlin, Germany. Included in the trial were children aged 6 to 11 years who did not follow a special diet or have food allergies and adult parents who served as the nutritional gatekeeper in the household (ie, the family member responsible for at least half of the food planning and preparation). All participants underwent 2 conditions: control, defined as regular family mealtime duration, and intervention, defined as 50% longer mealtime duration (10 minutes longer on average). Participants were randomized to the condition they would complete first. Statistical analyses of the full sample were conducted between June 2 and October 30, 2022.

INTERVENTIONS: Participants had 2 free evening meals under different conditions. In the control or regular condition, each dyad ate in the same amount of time as their reported regular mealtime duration. In the intervention or longer condition, each dyad had 50% more time to eat than their reported regular mealtime duration.

MAIN OUTCOMES AND MEASURES: The primary outcome was the number of pieces of fruits and vegetables eaten by the child during a meal.

RESULTS: A total of 50 parent-child dyads participated in the trial. Parents had a mean (range) age of 43 (28-55 years) years and were predominantly mothers (36 [72%]). Children had a mean (range) age of 8 (6-11) years and included an equal number of girls and boys (25 [50%]). Children ate significantly more pieces of fruits (t49 = 2.36, P = .01; mean difference [MD], 3.32 [95% CI, 0.96 to ∞]; Cohen d = 0.33) and vegetables (t49 = 3.66, P < .001; MD, 4.05 [95% CI, 2.19 to ∞]; Cohen d = 0.52) in the longer condition than in the regular mealtime duration condition. Consumption of bread and cold cuts did not significantly differ between conditions. The children’s eating rate (bites per minute over the regular mealtime duration) was significantly lower in the longer than in the regular condition (t49 = -7.60, P < .001; MD, -0.72 [95% CI, -0.56 to ∞]; Cohen d = 1.08). Children reported significantly higher satiety after the longer condition (V = 36.5, P < .001).

CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial suggest that the simple, low-threshold intervention of increasing family mealtime duration by approximately 10 minutes can improve the quality of children’s diet and eating behavior. The findings underscore the potential for such an intervention to improve public health.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03127579.

PMID:37010871 | DOI:10.1001/jamanetworkopen.2023.6331

JAMA Netw Open. 2023 Apr 3;6(4):e236438. doi: 10.1001/jamanetworkopen.2023.6438.

ABSTRACT

IMPORTANCE: The COVID-19 pandemic substantially disrupted routine health care and exacerbated existing barriers to health care access. Although postpartum women frequently experience pain that interferes with activities of daily living, which is often successfully treated with prescription opioid analgesics, they are also at high risk for opioid misuse.

OBJECTIVE: To compare postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study of 460 371 privately insured postpartum women who delivered a singleton live newborn between July 1, 2018, and December 31, 2020, postpartum opioid fills before March 1, 2020, were compared with fills after March 1, 2020. Statistical analysis was performed from December 1, 2021, to September 15, 2022.

EXPOSURE: COVID-19 pandemic onset in March 2020.

MAIN OUTCOMES AND MEASURES: The main outcome was postpartum opioid fills, defined as patient fills of opioid prescriptions during the 6 months after birth. Opioid prescriptions were explored in terms of 5 measures: mean number of fills per person, mean filled morphine milligram equivalents (MMEs) per day, mean days supplied, percentage of patients filling a prescription for a schedule II opioid, and percentage of patients filling a prescription for a schedule III or higher opioid.

RESULTS: Among 460 371 postpartum women (mean [SD] age at delivery, 29.0 [10.8] years), those who gave birth to a single, live newborn after March 2020 were 2.8 percentage points more likely to fill an opioid prescription than expected based on the preexisting trend (forecasted, 35.0% [95% CI, 34.0%-35.9%]; actual, 37.8% [95% CI, 36.8%-38.7%]). The COVID-19 period was also associated with an increase in MMEs per day (forecasted mean [SD], 34.1 [2.0] [95% CI, 33.6-34.7]; actual mean [SD], 35.8 [1.8] [95% CI, 35.3-36.3]), number of opioid fills per patient (forecasted, 0.49 [95% CI, 0.48-0.51]; actual, 0.54 [95% CI, 0.51-0.55]), and percentage of patients filling a schedule II opioid prescription (forecasted, 28.7% [95% CI, 27.9%-29.6%]; actual, 31.5% [95% CI, 30.6%-32.3%]). There was no significant association with days’ suppy of opioids per prescription or percentage of patients filling a prescription for a schedule III or higher opioid. Results stratified by delivery modality showed that the observed increases were larger for patients who delivered by cesarean birth than those delivering vaginally.

CONCLUSIONS AND RELEVANCE: This cross-sectional study suggests that the onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills. Increases in opioid prescriptions may be associated with increased risk of opioid misuse, opioid use disorder, and opioid-related overdose among postpartum women.

PMID:37010867 | DOI:10.1001/jamanetworkopen.2023.6438

JAMA. 2023 Apr 3. doi: 10.1001/jama.2023.4590. Online ahead of print.

NO ABSTRACT

PMID:37010865 | DOI:10.1001/jama.2023.4590

Musculoskeletal Care. 2023 Apr 3. doi: 10.1002/msc.1763. Online ahead of print.

ABSTRACT

OBJECTIVES: The aim of this study was to determine the prevalence, the main features and the potential risk factors of LBP in pregnant women.

METHODS: This cross-sectional study included 173 pregnant women in the third trimester. Non-inclusion criteria were severe mental disability and known previous history of musculoskeletal diseases. The participants were categorised into two groups: women with pregnancy-related LBP and pain-free women. Demographic, socio-professional, clinical and obstetrical data were compared between the two groups using the appropriate statistical tests.

RESULTS: The mean age was 32.2 ± 5.4 years [17-45]. Among them, 108 (62.4%) reported one or more episodes of LBP during at least 7 days, mostly in the third semester (n = 71). The presence of LBP was significantly associated with history of LBP in previous pregnancies and jobs requiring prolonged standing. Active jobs and the presence of gestational complications were significantly more common in pain-free women. In the multivariate analysis, LBP was independently predicted by the history of LBP in previous pregnancies and the absence of gestational complications.

CONCLUSIONS: The association of LBP with gestational complications as a protective factor has not yet been reported in previous studies. These complications are a common cause of hospitalisation, which represents a period of relative rest during pregnancy. Our results revealed that history of LBP in previous pregnancies, sedentary lifestyle prior to pregnancy and prolonged standing are the main risk factors of LBP. In contrast, rest and avoidance of physical overstrain during pregnancy may be protective factors.

PMID:37010863 | DOI:10.1002/msc.1763

Cancer Control. 2023 Jan-Dec;30:10732748231167958. doi: 10.1177/10732748231167958.

ABSTRACT

OBJECTIVE: We tested the performance of general machine learning and joint machine learning algorithms in the classification of bone metastasis, in patients with lung adenocarcinoma.

METHODS: We used R version 3.5.3 for statistical analysis of the general information, and Python to construct machine learning models.

RESULTS: We first used the average classifiers of the 4 machine learning algorithms to rank the features and the results showed that race, sex, whether they had surgery and marriage were the first 4 factors affecting bone metastasis. Machine learning results in the training group: for area under the curve (AUC), except for RF and LR, the AUC values of all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC for any single machine learning algorithm. Among the results related to accuracy and precision, the accuracy of other machine learning classifiers except the RF algorithm was higher than 70%, and only the precision of the LGBM algorithm was higher than 70%. Machine learning results in the test group: Similarly, for areas under the curve (AUC), except RF and LR, the AUC values for all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC value for any single machine learning algorithm. For accuracy, except for the RF algorithm, the accuracy of other machine learning classifiers was higher than 70%. The highest precision for the LGBM algorithm was .675.

CONCLUSION: The results of this concept verification study show that machine learning algorithm classifiers can distinguish the bone metastasis of patients with lung cancer. This will provide a new research idea for the future use of non-invasive technology to identify bone metastasis in lungcancer. However, more prospective multicenter cohort studies are needed.

PMID:37010850 | DOI:10.1177/10732748231167958

Neurogastroenterol Motil. 2023 Apr 3:e14582. doi: 10.1111/nmo.14582. Online ahead of print.

ABSTRACT

BACKGROUND: Data for Spain from the Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) were used to assess the national and regional prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in our country.

METHODS: Data were collected through an anonymous, nationwide, and secure Internet survey with multiple built-in quality-assurance techniques that included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire.

KEY RESULTS: The survey was completed by 2072 adult Spanish participants (50.2% female) with a mean age of 45.67 ± 15.44 years with a good representative national distribution. 43.6% (41.5%-45.8%) met diagnostic criteria for at least one DGBI, with 8.2% for any esophageal disorder, 12.1% for any gastroduodenal disorder, 30.1% for any bowel disorder, and 11.5% for any anorectal disorder. Functional constipation was the most prevalent DGBI in Spain (12.8%). We found that proctalgia fugax (9.3%), unspecified bowel disorders (10.8%), and functional dysphagia (5.6%) showed unexplained high rates in our country. DGBI rates were higher for women. Having any DGBI was negatively associated with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and associated with increased healthcare utilization.

CONCLUSIONS & INFERENCES: We provide the first comprehensive data on the prevalence and burden of all DGBI in Spain using the Rome IV criteria. The enormous burden of DGBI in Spain highlights the need for specialized training and future research.

PMID:37010843 | DOI:10.1111/nmo.14582

JAMA Pediatr. 2023 Apr 3. doi: 10.1001/jamapediatrics.2023.0346. Online ahead of print.

ABSTRACT

IMPORTANCE: Lithium is a naturally occurring and trace element that has mood-stabilizing effects. Maternal therapeutic use of lithium has been associated with adverse birth outcomes. In animal models, lithium modulates Wnt/β-catenin signaling that is important for neurodevelopment. It is unknown whether exposure to lithium in drinking water affects brain health in early life.

OBJECTIVE: To evaluate whether autism spectrum disorder (ASD) in offspring is associated with maternal exposure to lithium in drinking water during pregnancy.

DESIGN, SETTING AND PARTICIPANTS: This nationwide population-based case-control study in Denmark identified 8842 children diagnosed with ASD born from 2000 through 2013 and 43 864 control participants matched by birth year and sex from the Danish Medical Birth Registry. These data were analyzed from March 2021 through November 2022.

EXPOSURES: Geocoded maternal residential addresses during pregnancy were linked to lithium level (range, 0.6 to 30.7 μg/L) in drinking water estimated using kriging interpolation based on 151 waterworks measurements of lithium across all regions in Denmark.

MAIN OUTCOMES AND MEASURES: ASD diagnoses were ascertained using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes recorded in the Danish Psychiatric Central Register. The study team estimated odds ratios (ORs) and 95% CIs for ASD according to estimated geocoded maternal exposure to natural source of lithium in drinking water as a continuous (per IQR) or a categorical (quartile) variable, adjusting for sociodemographic factors and ambient air pollutants levels. The study team also conducted stratified analyses by birth years, child’s sex, and urbanicity.

RESULTS: A total of 8842 participants with ASD (male, 7009 [79.3%]) and 43 864 control participants (male, 34 749 [79.2%]) were studied. Every IQR increase in estimated geocoded maternal exposure to natural source of lithium in drinking water was associated with higher odds for ASD in offspring (OR, 1.23; 95% CI, 1.17-1.29). Elevated odds among offspring for ASD were estimated starting from the second quartile (7.36 to 12.67 μg/L) of estimated maternal exposure to drinking water with lithium and the OR for the highest quartile (more than 16.78 μg/L) compared with the reference group (less than 7.39 μg/L) was 1.46 (95% CI, 1.35-1.59). The associations were unchanged when adjusting for air pollution exposures and no differences were apparent in stratified analyses.

CONCLUSIONS AND RELEVANCE: Estimated maternal prenatal exposure to lithium from naturally occurring drinking water sources in Denmark was associated with an increased ASD risk in the offspring. This study suggests that naturally occurring lithium in drinking water may be a novel environmental risk factor for ASD development that requires further scrutiny.

PMID:37010840 | DOI:10.1001/jamapediatrics.2023.0346

Infection. 2023 Apr 3. doi: 10.1007/s15010-023-02015-w. Online ahead of print.

NO ABSTRACT

PMID:37010806 | DOI:10.1007/s15010-023-02015-w

Qual Life Res. 2023 Apr 3. doi: 10.1007/s11136-023-03398-x. Online ahead of print.

ABSTRACT

PURPOSE: To estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D).

METHODS: Cross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants’ glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group.

RESULTS: The mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79-0.81), in prediabetes, 0.81 (95% CI 0.79-0.83), and in participants with UT2D of 0.79 (95% CI 0.76-0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis.

CONCLUSIONS: HRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

PMID:37010804 | DOI:10.1007/s11136-023-03398-x

J Am Geriatr Soc. 2023 Apr 3. doi: 10.1111/jgs.18357. Online ahead of print.

ABSTRACT

BACKGROUND: Relatively little is known about how distressing symptoms change among older persons in the setting of major surgery. Our objective was to evaluate changes in distressing symptoms after major surgery and determine whether these changes differ according to the timing of surgery (nonelective vs. elective), sex, multimorbidity, and socioeconomic disadvantage.

METHODS: From a prospective longitudinal study of 754 nondisabled community-living persons, 70 years of age or older, 368 admissions for major surgery were identified from 274 participants who were discharged from the hospital from March 1998 to December 2017. The occurrence of 15 distressing symptoms was ascertained in the month before and 6 months after major surgery. Multimorbidity was defined as more than two chronic conditions. Socioeconomic disadvantage was assessed at the individual level, based on Medicaid eligibility, and neighborhood level, based on an area deprivation index (ADI) score above the 80th state percentile.

RESULTS: In the month before major surgery, the occurrence and mean number of distressing symptoms were 19.6% and 0.75, respectively. In multivariable analyses, the rate ratios, denoting proportional increases in the 6 months after major surgery relative to presurgery values, were 2.56 (95% confidence interval [CI], 1.91-3.44) and 2.90 (95% CI, 2.01-4.18) for the occurrence and number of distressing symptoms, respectively. The corresponding values were 3.54 (95% CI, 2.06-6.08) and 4.51 for nonelective surgery (95% CI, 2.32-8.76) and 2.12 (95% CI, 1.53-2.92) and 2.20 (95% CI, 1.48-3.29) for elective surgery; p-values for interaction were 0.030 and 0.009. None of the other subgroup differences were statistically significant, although men had a greater proportional increase in the occurrence and number of distressing symptoms than women.

CONCLUSIONS: Among community-living older persons, the burden of distressing symptoms increases substantially after major surgery, especially in those having nonelective procedures. Reducing symptom burden has the potential to improve quality of life and enhance functional outcomes after major surgery.

PMID:37010784 | DOI:10.1111/jgs.18357