Category: Nevin Manimala

Eur Eat Disord Rev. 2022 Feb 7. doi: 10.1002/erv.2888. Online ahead of print.

ABSTRACT

OBJECTIVE: Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design.

METHOD: Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0-16.4 kg/m² ), underweight (BMI 16.5-18.4 kg/m² ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m² ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m² ) or non-weight restored (BMI < 18.5 kg/m² ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA).

RESULTS: Both groups experienced improvements in eating disorder symptoms and measures of psychological well-being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ-8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria-which excluded comorbid BPD-led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort.

CONCLUSIONS: Although the small sample size must be noted as a limitation-the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study.

PMID:35132749 | DOI:10.1002/erv.2888

Int J Lab Hematol. 2022 Feb 7. doi: 10.1111/ijlh.13805. Online ahead of print.

ABSTRACT

INTRODUCTION: Increased antiphospholipid antibodies (aPL) have been described in human immunodeficiency virus (HIV) infection. However, the association between aPL and the increased risk of thrombosis in HIV requires further clarification.

METHODS: We reviewed the medical records of 215 consecutive women with a history of thrombosis and/or obstetric complications (158 HIV-uninfected and 57 HIV-infected) between July 2017 and March 2021. Participants (n = 215) without clinical criteria manifestations for antiphospholipid syndrome were included as matched controls. Testing for lupus anticoagulant (LAC), anticardiolipin (aCL) and anti-beta2-glycoprotein1 (aβ2GP1) IgM and IgG was performed.

RESULTS: Thirty-two (10.1%) HIV-uninfected and 15 (13.2%) HIV-infected participants were positive at baseline for one of the five criteria aPL, with no statistically significant difference. The profile of the HIV-infected participants with thrombosis (n = 11) included LAC in 15.8%, aCL IgG in 3.5% and aβ2GP1 IgG in 1.8%. In contrast, the HIV-infected controls (n = 4), included aCL IgM in 1.8% and aβ2GP1 IgM in 5.3%. Only LAC was significantly associated with thrombosis (p < 0.003). On repeat testing, in a HIV-infected sub-population, 2/7 with thrombosis were positive, while 3/3 controls tested negative.

CONCLUSION: In contrast to earlier reports, the prevalence and expression of aPL in HIV-infected women with a history of thrombosis in the present study, in the era of antiretroviral therapy, were similar to HIV-uninfected women. Baseline LAC positivity was associated with a significantly increased risk for thrombosis in HIV. Future studies are recommended to explore additional coagulation abnormalities in HIV.

PMID:35132770 | DOI:10.1111/ijlh.13805

J Cosmet Dermatol. 2022 Feb 7. doi: 10.1111/jocd.14757. Online ahead of print.

ABSTRACT

BACKGROUND: Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients.

METHODS: From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the “three-point” injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications.

RESULTS: All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients.

CONCLUSIONS: Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The “three-point” technique is simple, safe, and effective and does not cause serious complications.

PMID:35132743 | DOI:10.1111/jocd.14757

Ultrasound Obstet Gynecol. 2022 Feb 8. doi: 10.1002/uog.24875. Online ahead of print.

ABSTRACT

INTRODUCTION: While visualization of fetal anatomy is one of the primary purposes of diagnostic ultrasound, the application of statistical analysis to biological measurements of fetal structures such as the head, abdomen, long bones, and heart, requires equations that compute changes in these measurements over time. One of the challenges for the investigator who desires to compute reference intervals for a fetal measurement is selecting the best equation for the measurements of interest. Fractional polynomial regression equations have been used to describe changes in fetal measurements over time and consists of 44 equations for the investigator to select. Since it would be laborious to analyze each equation to identify the best fit of the data, software programs have been developed for such analysis. However, depending upon the software program, potential errors can occur when translating the coefficients of a complex equation to a format that can be used by the clinician to create reference interval tables and graphs.

METHODS: This study reviews the requirements for statistical output that allows the investigator to generate reference interval tables and graphs using Excel.

RESULTS: A step-by-step sequence is explained that enables the investigator to minimize the possibility of errors when reporting complex equations and their associated graphs that result from fractional polynomial regression analysis.

CONCLUSION: Using the techniques described in this opinion paper should decrease the potential for reporting erroneous equations used to compute reference interval tables and graphs. This article is protected by copyright. All rights reserved.

PMID:35132716 | DOI:10.1002/uog.24875

Int J Methods Psychiatr Res. 2022 Feb 7:e1906. doi: 10.1002/mpr.1906. Online ahead of print.

ABSTRACT

OBJECTIVE: One of the primary tools in the assessment of individual-level patient outcomes is Jacobson and Truax, (1991’s) Reliable Change Index (RCI). Recent efforts to optimize the RCI have revolved around three issues: (a) extending the RCI beyond two timepoints, (b) estimating the RCI using scale scores from item response theory or factor analysis and (c) estimation of person- and time-specific standard errors of measurement.

METHOD: We present an adaptation of a two-stage procedure, a measurement error-corrected multilevel model, as a tool for RCI estimation (with accompanying Statistical Analysis System syntax). Using DASS-21 data from a community-based mental health center (N = 379), we illustrate the potential for the model as unifying framework for simultaneously addressing all three limitations in modeling individual-level RCI estimates.

RESULTS: Compared to the optimal-fitting RCI model (moderated nonlinear factor analysis scoring with measurement error correction), an RCI model that uses DASS-21 total scores produced errors in RCI inferences in 50.8% of patients; this was largely driven by overestimation of the proportion of patients with statistically significant improvement.

CONCLUSION: Estimation of the RCI can now be enhanced by the use of latent variables, person- and time-specific measurement errors, and multiple timepoints.

PMID:35132724 | DOI:10.1002/mpr.1906

Int J Paediatr Dent. 2022 Feb 7. doi: 10.1111/ipd.12956. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the trabecular bone density in the mandible diagnosed with sleep bruxism (SB) using the fractal analysis method on panoramic radiographs.

METHODS: 37 patients whose anamnesis and clinical signs were compatible with SB were diagnosed with SB using BiteStrip®. Three areas were identified on the panoramic radiographs of the patients: geometric center of the condyle, angulus region under the mandibular canal, and distal region of mental foramen. ROIs of 60×60 pixels were selected in these three locations, and fractal dimensions (FD) were calculated. Results were compared and analyzed with the control group.

RESULTS: There was no statistically significant difference between right and left FD values, also, male and female FD values in the all regions and both groups. (p>0,05) In the angulus (p=0.03) and condyle (p=0.03) regions, SB group had a significantly higher FD value than control group. There was no statistically significant difference between SB and control groups in the corpus region. (p=0.98) A moderate negative correlation arose between age and condyle FD values among controls. (r= -0.38, p=0.02) CONCLUSION: FD value evaluating trabeculation of the mandibular bone are affected by SB in the angulus and condyle regions.

PMID:35132715 | DOI:10.1111/ipd.12956

J Neuroendocrinol. 2022 Jan 23:e13096. doi: 10.1111/jne.13096. Online ahead of print.

ABSTRACT

CALM-NET was a phase IV exploratory study in the UK that aimed to evaluate if the presence of circulating tumour cells (CTCs) at baseline predicted symptomatic response in patients with midgut neuroendocrine tumours (NETs) treated with lanreotide autogel (LAN). Adults with functional, well/moderately differentiated (Ki-67 <20%) midgut NETs received LAN 120 mg/28 days for 1 year. CTCs were present in blood if enumeration was >0. Primary endpoint was the clinical value of baseline CTCs to predict symptomatic response (decrease in diarrhoea or flushing of ≥50% frequency, or ≥1 severity level). Other endpoints included progression-free survival (PFS) and correlations between plasma and urinary biomarkers (including 5-hydroxyindoleacetic acid [5-HIAA]). Fifty patients were enrolled; 40 completed the study. Baseline CTCs were present in 22 (45.8%) patients (missing baseline CTC status n = 2). Overall, 87.5% (95% confidence interval [CI]: 73.9; 94.5) of patients had a symptomatic response; a 5.9-fold higher odds of symptomatic response in patients without CTC versus patients with CTC at baseline was observed, although this was not statistically significant (odds ratio: 0.17 [95% CI: 0.02; 1.65], p = .126). One-year PFS rate was 66.4% (95% CI: 48.8; 79.2). Biomarker concentrations did not correlate to baseline CTC status. However, there was a strong correlation between plasma and urinary 5-HIAA (Spearman correlation coefficients ≥0.87 [p < .001], all time points). In conclusion, patients without CTC at baseline may be more likely to achieve a symptomatic response following LAN treatment than patients with CTC. Plasma 5-HIAA correlated with urinary 5-HIAA during LAN treatment. ClinicalTrials.gov identifier: NCT02075606.

PMID:35132704 | DOI:10.1111/jne.13096

J Clin Nurs. 2022 Feb 7. doi: 10.1111/jocn.16235. Online ahead of print.

ABSTRACT

BACKGROUND: Prescription opioid use is a global health issue. Previous systematic reviews have not identified that any specific intervention supports prescription opioid reduction effectively. In keeping with the nature of a scoping review, this review details an overview of the existing literature on this topic, with quality of evidence being discussed rather than formally analysed.

AIM: This review aimed to examine and describe outpatient interventions that support the reduction of prescription opioid medication for chronic non cancer pain.

ELIGIBILITY CRITERIA: Abstracts were reviewed against the inclusion criteria of outpatient clinical interventions, for the purpose of prescription opioid dose reduction, offered to adults with CNCP.

SOURCES OF EVIDENCE: Following a structured review approach an electronic database search, of Medline, Embase, Cochrane, Cinahl, and Proquest and grey literature was undertaken. Search results were screened by title for relevance.

CHARTING METHODS: Two reviewers adhering to the PRISMA-ScR checklist charted and assessed studies for quality using Critical Appraisal Skills Programme checklist assessment tools. Extracted data were collated and synthesised for presentation as a tabular and narrative review.

RESULTS: From the initial search of 5089 papers, 19 underwent full-text review and quality appraisal. A variety of interventions were described to support reduction in prescription opioid use, however only one study of at least fair quality was able to demonstrate a demonstrated a statistically significant benefit in reducing measured opioid dose compared with a control group. Interventions were implemented in both specialist pain services and in primary care with multidisciplinary and interdisciplinary clinician care. Barriers and facilitators were observed in both settings.

CONCLUSION AND IMPLICATIONS FOR CLINICAL PRACTICE: Further rigorous research needs to be conducted to conclusively answer the question of what outpatient interventions support opioid reduction in chronic non cancer pain. This scoping review is the first step of inquiry in the development of a nursing intervention to support reduction of prescription opioids.

PMID:35132707 | DOI:10.1111/jocn.16235

Clin Exp Allergy. 2022 Feb 7. doi: 10.1111/cea.14106. Online ahead of print.

ABSTRACT

INTRODUCTION: Gastroesophageal reflux disease (GERD) is the most common non-allergic comorbidity in adults with asthma, however comorbidity with other atopic diseases such as eczema and hayfever is unclear. The objective was to assess the comorbidity of GERD with asthma and atopic diseases, and to investigate possible mechanisms, including genetic and/or affective factors.

METHODS: A co-twin control study harnessing 46 583 adult twins. Questionnaires on health status were linked to national patient and prescribed drug register data. Analyses tested associations of comorbidity between multiple definitions of atopic diseases (self-report and register-based) with GERD. Comparisons were made between unpaired, monozygotic (MZ) and dizygotic (DZ) twins to assess genetic liability. Affective traits (depression, anxiety and neuroticism) were added to models as possible explanatory factors.

RESULTS: The risk of GERD in those with: asthma was OR (odds ratio) 1.52 (95% CI 1.38, 1.68), hayfever OR 1.22 (95%CI 1.12, 1.34), and eczema OR 1.23 (95%CI 1.10, 1.38). Adjusting for affective traits completely attenuated the comorbidity associations for hayfever and eczema with GERD, and partly for asthma with GERD. Co-twin control associations attenuated suggesting a shared cause for both GERD and atopic diseases. For example, all twins adjOR 1.32 (95%CI 1.00, 1.74), 0.97 (95% CI 0.76-1.23), 1.11 (95%CI 0.85-1.45) for self-report asthma, hayfever and eczema with GERD respectively.

CONCLUSIONS: GERD is a common comorbidity in adults with asthma, hayfever and/or eczema. We found evidence for shared mechanisms suggesting common underlying causes that may involve affective traits requiring further investigation.

PMID:35132702 | DOI:10.1111/cea.14106

Int J Eat Disord. 2022 Feb 7. doi: 10.1002/eat.23688. Online ahead of print.

ABSTRACT

BACKGROUND: Research indicates that difficulties across multiple socioemotional functioning domains (e.g., social emotion expression/regulation, response to social elicitors of emotion) and negatively biased interpretations of ambiguous social situations may affect eating disorder symptoms. The impact of inflexible interpretations of social situations on eating disorder symptoms is less clear. The present study therefore examined relations between inflexible and biased social interpretations, socioemotional functioning, and eating disorder symptoms.

METHOD: A total of 310 participants from the general population, recruited from an online crowdsourcing platform, completed measures of socioemotional functioning (e.g., rejection sensitivity, negative social exchange), eating disorder symptoms, and positive and negative interpretation bias and inflexibility on a single measurement occasion.

RESULTS: Socioemotional functioning impairments (Pillai’s trace = 0.11, p < .001), but not negative (β = .07, p = .162) or positive (β = -.01, p = .804) interpretation bias or inflexible interpretations (β = .04, p = .446), were associated with eating disorder symptoms in multiple regression models. In network analyses controlling statistically for multiple markers of socioemotional functioning, eating disorder symptoms were directly associated with negative (but not positive) interpretation bias. Inflexible interpretations were indirectly linked to symptoms via co-dampening of positive emotions. Exploratory causal discovery analyses suggested that several socioemotional functioning variables (social anxiety, depression, negative social exchange) may cause eating disorder symptoms.

CONCLUSIONS: Consistent with cognitive-interpersonal models of disordered eating, our results suggest that less accurate (biased, inflexible) interpretations of social information contribute to patterns of cognition (anxious anticipation of rejection) and emotion regulation (down-regulation of positive social emotion) thought to encourage disordered eating.

PUBLIC SIGNIFICANCE: This study suggests that less accurate interpretations of ambiguous social information encourage anxious anticipation of rejection and downregulation of positive social emotions, both of which are thought to promote eating disorder symptoms. Knowledge provided by this study about the likely relations between interpretive processes, social/emotional functioning, and eating disorder symptoms may help inform treatments for eating disorders, particularly those that attempt to modify patterns of interpretation.

PMID:35132668 | DOI:10.1002/eat.23688