Category: Nevin Manimala

Asian Pac J Cancer Prev. 2023 Apr 1;24(4):1105-1111. doi: 10.31557/APJCP.2023.24.4.1105.

ABSTRACT

OBJECTIVE: To determine the risk factors associated the incidence of NPC, particularly in Indonesia.

METHODS: This systematic review and meta-analysis was conducted according to PRISMA statement. Database including PubMed, Scopus, Science Direct, Web of Science, and GARUDA were retrieved. Newcastle-Ottawa scale was used to assess the quality of published study and analyse the risk of bias of included study. Random-effect model and reported pooled Odds Ratio (OR) with 95%CI was carried out in our meta-analysis.

RESULTS: A pooled of 7 studies were included in our study which included 764 participants. We found that female gender was not associated with the incidences of NPC (OR 1.45, 95% CI: 0.61-3.45, p=0.40), and smoking was highly increased the incidence of NPC (OR 4.39 95% CI (0.79-24.40), but not statistically significant (p=0.09). Furthermore, salted fish consumption and some HLA alleles were associated with increased risk.

CONCLUSION: The incidence of NPC is not associated with female gender nor smoking habits. However, the risk of NPC is higher for those who consume salted fish and have some susceptible HLA alleles. Further investigations in larger studies are needed to confirm these findings.

PMID:37116129 | DOI:10.31557/APJCP.2023.24.4.1105

Afr J AIDS Res. 2023 Apr;22(1):63-68. doi: 10.2989/16085906.2023.2188232.

ABSTRACT

Background: Multi-month dispensing (MMD) of antiretroviral therapy has demonstrated benefits for HIV patients and health service delivery systems, including reduced frequency of hospital visits and improved retention. We evaluated the effect of 6-monthly dispensing (MMD6) on patient clinic attendance at a single military facility in the one-year pre- and post-policy change.Methods: This was a descriptive, retrospective, cross-sectional study, exploring the relationship between MMD6 and clinic attendance numbers. We reviewed aggregate clinic attendance records for clients on ART and documented monthly trends in clinic attendance numbers, number of clients current on ART, and amount of ART dispensed.Results: In the pre-MMD6 group, 4 150 patients were included, and 4 190 in the post-MMD6 group. Clinic attendance was 30 407 visits (16 111 pre-MMD6 and 14 296 post-MMD6). An overall mean increase of 326.58 ± 861.81 (95% CI = -874.15 ± 220.98) drugs were dispensed per month; t(11) = -1.31, p = 0.22; mean monthly clinic attendance declined from 1342.8 ± 220.10 visits pre-MMD6 to 1191.33 ± 309.10 post-MMD6 with t(11) = 1.601, p = 0.14, but was not statistically significant.Conclusion: Six-monthly dispensing can be an important tool to reduce HIV clinic volumes and improve antiretroviral access. It is particularly important for care continuity in military facilities where service members may be deployed or transferred to other bases along with their dependents.

PMID:37116113 | DOI:10.2989/16085906.2023.2188232

Afr J AIDS Res. 2023 Apr;22(1):54-62. doi: 10.2989/16085906.2023.2186252.

ABSTRACT

Globally, mental health problems have been reported to be more common in youth living with HIV (YLWH) than in the general population, but routine mental health screening is rarely done in high-volume HIV clinics. In 2019, YLWH in a large HIV clinic in Botswana were screened using the Generalized Anxiety Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) in a pilot standard-of-care screening programme. Two-way ANOVA was used to describe the effects of age group (12-<16, 16-<20 and 20-25 years old) and sex on GAD-7 and PHQ-9 scores. Chi-square statistics were used to compare characteristics of YLWH with and without potential suicidality/self-harm symptoms based on question 9 in the PHQ-9. Among 1 469 YLWH, 33.1%, 44.3% and 15.0% had anxiety, depression and potential suicidality/self-harm symptoms respectively. YLWH of 20-25 years old and 16-<20 years old had higher GAD-7 scores compared to 12-<16-year-olds (p = 0.014 and p = <0.001 respectively). Female YLWH of 20-25 years old had higher PHQ-9 scores compared to 12-<16-year-olds (p = 0.002). There were no other sex-age dynamics that were statistically significant. Female YLWH endorsed more thoughts of suicidality/self-harm than males (17% versus 13%, p = 0.03 respectively). Given the proportion of YLWH with mental health symptoms, Botswana should enhance investments in mental health services for YLWH, especially for young female adults who bear a disproportionate burden.

PMID:37116112 | DOI:10.2989/16085906.2023.2186252

J Am Chem Soc. 2023 Apr 28. doi: 10.1021/jacs.3c01597. Online ahead of print.

ABSTRACT

Peripheral membrane proteins can adopt distinct orientations on the surfaces of lipid bilayers that are often short-lived and challenging to characterize by conventional experimental methods. Here we describe a robust approach for mapping protein orientational landscapes through quantitative interpretation of paramagnetic relaxation enhancement (PRE) data arising from membrane mimetics with spin-labeled lipids. Theoretical analysis, followed by experimental verification, reveals insights into the distinct properties of the PRE observables that are generally distorted in the case of stably membrane-anchored proteins. To suppress the artifacts, we demonstrate that undistorted Γ₂ values can be obtained via transient membrane anchoring, based on which a computational framework is established for deriving accurate orientational ensembles obeying Boltzmann statistics. Application of the approach to KRas4B, a classical peripheral membrane protein whose orientations are critical for its functions and drug design, reveals four distinct orientational states that are close but not identical to those reported previously. Similar orientations are also found for a truncated KRas4B without the hypervariable region (HVR) that can sample a broader range of orientations, suggesting a confinement role of the HVR geometrically prohibiting severe tilting. Comparison of the KRas4B Γ₂ rates measured using nanodiscs containing different types of anionic lipids reveals identical Γ₂ patterns for the G-domain but different ones for the HVR, indicating only the latter is able to selectively interact with anionic lipids.

PMID:37116086 | DOI:10.1021/jacs.3c01597

J Assoc Physicians India. 2023 Jan;71(1):1.

ABSTRACT

INTRODUCTION: Portal hypertensive gastropathy (PHG) is known but under detected complication of cirrhosis of liver. Patients with stable liver disease are more prone to internal bleeding due to portal hypertension. Thrombocytopenia is a common complication associated with chronic liver disease and it is associated with poor prognosis. The aim of this study is to find out the association between correlation between severity of thrombocytopenia and portal hypertensive gastropathy in patients with chronic liver disease.

MATERIALS: This cross-sectional analytical study was conducted in a tertiary care centre at Saveetha Medical College Hospital and Research Centre. A total of 80 consecutive subjects were included in this study. All adult patients admitted with diagnosis chronic liver disease underwent upper GI endoscopy; those with portal hypertensive gastropathy were included in this study. The patient with liver disease with only varices but not gastropathy was excluded. Patient less than 18 years and with poor preparation were excluded from this study. Platelet count was estimated and severity of gastropathy was classified. Correlation of thrombocytopenia and severity of gastropathy was studied.

RESULT: Patients with mild portal hypertensive gastropathy category had normal platelet count between 1.5-4.5 lakhs/mm3 . But in patients with severe PHG, almost 80% of patients had thrombocytopenia, in which 8% had severe thrombocytopenia &lt;50,000 cells/mm3 . The inverse relationship between the platelet count and the severity of PHG was statistically significant.

CONCLUSION: The severity of thrombocytopenia increased with increasing grade of portal hypertensive gastropathy. Hence platelet count can serve as the prognostic marker of chronic liver disease induced portal hypertensive gastropathy References Chung WJ. Management of portal hypertensive gastropathy and other bleeding. Clin Mol Hepatol 2014;20(1):1-5. Madhwani R, Hanif FM, Ul Haque MM, et al. Noninvasive clinical predictors of portal hypertensive gastropathy in patients with liver cirrhosis. J Transpl Int Med 2017;5(3):169-173.

PMID:37116043

J Med Internet Res. 2023 Apr 28;25:e43862. doi: 10.2196/43862.

ABSTRACT

BACKGROUND: Mental health problems are a crucial global public health concern. Owing to their cost-effectiveness and accessibility, conversational agent interventions (CAIs) are promising in the field of mental health care.

OBJECTIVE: This study aims to present a thorough summary of the traits of CAIs available for a range of mental health problems, find evidence of efficacy, and analyze the statistically significant moderators of efficacy via a meta-analysis of randomized controlled trial.

METHODS: Web-based databases (Embase, MEDLINE, PsycINFO, CINAHL, Web of Science, and Cochrane) were systematically searched dated from the establishment of the database to October 30, 2021, and updated to May 1, 2022. Randomized controlled trials comparing CAIs with any other type of control condition in improving depressive symptoms, generalized anxiety symptoms, specific anxiety symptoms, quality of life or well-being, general distress, stress, mental disorder symptoms, psychosomatic disease symptoms, and positive and negative affect were considered eligible. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were extracted by 2 independent reviewers, checked by a third reviewer, and pooled using both random effect models and fixed effects models. Hedges g was chosen as the effect size.

RESULTS: Of the 6900 identified records, a total of 32 studies were included, involving 6089 participants. CAIs showed statistically significant short-term effects compared with control conditions in improving depressive symptoms (g=0.29, 95% CI 0.20-0.38), generalized anxiety symptoms (g=0.29, 95% CI 0.21-0.36), specific anxiety symptoms (g=0.47, 95% CI 0.07-0.86), quality of life or well-being (g=0.27, 95% CI 0.16-0.39), general distress (g=0.33, 95% CI 0.20-0.45), stress (g=0.24, 95% CI 0.08-0.41), mental disorder symptoms (g=0.36, 95% CI 0.17-0.54), psychosomatic disease symptoms (g=0.62, 95% CI 0.14-1.11), and negative affect (g=0.28, 95% CI 0.05-0.51). However, the long-term effects of CAIs for the most mental health outcomes were not statistically significant (g=-0.04 to 0.39). Personalization and empathic response were 2 critical facilitators of efficacy. The longer duration of interaction with conversational agents was associated with the larger pooled effect sizes.

CONCLUSIONS: The findings show that CAIs are research-proven interventions that ought to be implemented more widely in mental health care. CAIs are effective and easily acceptable for those with mental health problems. The clinical application of this novel digital technology will conserve human health resources and optimize the allocation of mental health services.

TRIAL REGISTRATION: PROSPERO CRD42022350130; https://tinyurl.com/mvhk6w9p.

PMID:37115595 | DOI:10.2196/43862

J Anal Psychol. 2023 Apr;68(2):301-326. doi: 10.1111/1468-5922.12903.

ABSTRACT

The main objective of this qualitative and quantitative research paper is to explore the occurrences and relations of the anima, animus and androgynous in dreams, with particular emphasis on the consideration of the androgynous in the human psyche. The sample consists of 9 series of dreams (141 dreams in total), from 9 dreamers, 7 women (female sex/gender) and 2 men (male sex/gender), aged 25-57, heterosexual, undergoing Jungian psychotherapy, and presenting couple-related themes. Statistical results and qualitative analysis offer new input for the re-vision of the classical anima-animus model, and the addition of in-depth explorations into the androgynous, paving the way for a new model of psychopathology and psychotherapeutic clinical work, in transition.

PMID:37115574 | DOI:10.1111/1468-5922.12903

JAMA Netw Open. 2023 Apr 3;6(4):e2310550. doi: 10.1001/jamanetworkopen.2023.10550.

ABSTRACT

IMPORTANCE: Evidence suggests that individuals with schizophrenia are at an increased risk of hip fractures; however, the sex-specific burden of hip fractures among adults with schizophrenia has not been quantified and compared with the general population.

OBJECTIVE: To describe sociodemographic and clinical characteristics of patients with hip fracture and schizophrenia and to quantify their sex-specific annual hip fracture rates relative to those without schizophrenia.

DESIGN, SETTING, AND PARTICIPANTS: This repeated population-based, cross-sectional study leveraged multiple individually linked health administrative databases for patients in Ontario, Canada. We included patients aged 40 to 105 years with hip fracture-related hospitalization between April 1, 2009, and March 31, 2019. Statistical analysis was performed between November 2021 and February 2023.

EXPOSURE: Schizophrenia diagnosis, ascertained using a validated algorithm.

MAIN OUTCOMES AND MEASURES: The main outcome was sex-specific age-standardized annual hip fracture rate per 10 000 individuals and annual percent change in age-standardized rates. Rates were direct adjusted to the 2011 Ontario population, and joinpoint regression analysis was performed to evaluate annual percent change.

RESULTS: We identified 117 431 hip fracture records; of these, there were 109 908 index events. Among the 109 908 patients with hip fracture, 4251 had schizophrenia and 105 657 did not. Their median age was 83 years (IQR, 75-89 years), and 34 500 (31.4%) were men. Patients with hip fracture and schizophrenia were younger at the index event compared with those without schizophrenia. Men had a median age of 73 vs 81 years (IQR, 62-83 vs 71-87 years; standardized difference, 0.46), and women had a median age of 80 vs 84 years (IQR, 71-87 vs 77-89 years; standardized difference, 0.32). A higher proportion of patients with vs without schizophrenia had frailty (53.7% vs 34.2%; standardized difference, 0.40) and previous fragility fractures (23.5% vs 19.1%; standardized difference, 0.11). The overall age-standardized rate per 10 000 individuals with vs without schizophrenia was 37.5 (95% CI, 36.4 to 38.6) vs 16.0 (95% CI, 15.9 to 16.1). Age-standardized rates were 3-fold higher in men with vs without schizophrenia (31.0 [95% CI, 29.5 to 32.6] vs 10.1 [95% CI, 10.0 to 10.2]) and more than 2-fold higher in women with vs without schizophrenia (43.4 [95% CI, 41.9 to 44.9] vs 21.4 [95% CI, 21.3 to 21.6]). Overall, joinpoint regression analysis identified a steady annual decrease of 0.7% (95% CI, -1.1% to -0.3%) in age-standardized rates for both study groups.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that individuals with schizophrenia experience an earlier age of onset and considerably higher rate of hip fractures compared with the general population, with implications for targeted fracture prevention and optimization of clinical bone health management over the course of their psychiatric illness.

PMID:37115547 | DOI:10.1001/jamanetworkopen.2023.10550

JAMA Netw Open. 2023 Apr 3;6(4):e2310999. doi: 10.1001/jamanetworkopen.2023.10999.

ABSTRACT

IMPORTANCE: Characterizing the extent and pattern of unmet needs for treatment of children with attention-deficit/hyperactivity disorder (ADHD) could help target efforts to improve access to ADHD medications and outpatient mental health care.

OBJECTIVE: To describe current ADHD medication use and lifetime outpatient mental health care among a large national sample of children with ADHD.

DESIGN, SETTING, AND PARTICIPANTS: This study uses cross-sectional survey data from the first wave of the Adolescent Brain and Cognitive Development Study (n = 11 723), conducted from June 1, 2016, to October 15, 2018, among 1206 school children aged 9 and 10 years who met parent-reported Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for current ADHD. Statistical analysis was performed from March 23, 2022, to March 10, 2023.

MAIN OUTCOMES AND MEASURES: Current ADHD medications including stimulants and nonstimulants, lifetime outpatient mental health care, or either treatment. Weighted results are reported.

RESULTS: Among a sample of 11 723 children, 1206 had parent-reported ADHD (aged 9-10 years; 826 boys [68.2%]; 759 White, non-Hispanic children [62.2%]), 149 (12.9%) were currently receiving ADHD medications. Children receiving ADHD medications included a significantly higher percentage of boys (15.7% [121 of 826]) than girls (7.0% [28 of 108]), White children (14.8% [104 of 759]) than Black children (9.4% [22 of 206]), children of parents without a high school education (32.2% [9 of 36]) than of parents with a bachelor’s degree or higher (11.5% [84 of 715]), and children with the combined subtype of ADHD (17.0% [83 of 505]) than with the inattentive subtype (9.5% [49 of 523]). Approximately 26.2% of children (301 of 1206) with parent-reported ADHD had ever received outpatient mental health care. Children receiving outpatient mental health care included a significantly higher percentage of children whose parents had a high school education (36.2% [29 of 90]) or some college (31.0% [109 of 364]) than a bachelor’s degree or higher (21.3% [153 of 715]), children with family incomes of less than $25 000 (36.5% [66 of 176]) or $25 000 to $49 999 (27.7% [47 of 174]) than $75 000 or more (20.1% [125 of 599]), and children with the combined subtype of ADHD (33.6% [166 of 505]) than with the predominantly inattentive subtype (20.0% [101 of 523]) or the hyperactive-impulsive subtype (22.4% [34 of 178]) of ADHD.

CONCLUSIONS AND RELEVANCE: This cross-sectional study of children with parent-reported ADHD suggests that most were not receiving ADHD medications and had never received outpatient mental health care. Gaps in treatment, which were not directly associated with socioeconomic disadvantage, underscore the challenges of improving communication and access to outpatient mental health care for children with ADHD.

PMID:37115542 | DOI:10.1001/jamanetworkopen.2023.10999

JAMA Netw Open. 2023 Apr 3;6(4):e2311004. doi: 10.1001/jamanetworkopen.2023.11004.

ABSTRACT

IMPORTANCE: Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings.

OBJECTIVE: To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022.

INTERVENTION: The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline.

MAIN OUTCOMES AND MEASURES: Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months.

RESULTS: The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02795104.

PMID:37115541 | DOI:10.1001/jamanetworkopen.2023.11004