Nevin Manimala

J Am Geriatr Soc. 2021 Jun 7. doi: 10.1111/jgs.17286. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients’ sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients’ sedentary behavior.

DESIGN: Cluster randomized controlled trial (c-RCT).

SETTING: Dutch homecare (10 nursing teams comprising a total of 313 staff members).

PARTICIPANTS: 264 clients (aged ≥65 years).

INTERVENTION: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.

MEASUREMENTS: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.

RESULTS: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.

CONCLUSION: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

PMID:34097301 | DOI:10.1111/jgs.17286

J Am Geriatr Soc. 2021 Jun 7. doi: 10.1111/jgs.17295. Online ahead of print.

ABSTRACT

BACKGROUND/OBJECTIVES: Hypertension treatment reduces cardiovascular events. However, uncertainty remains about benefits and harms of deintensification or further intensification of antihypertensive medication when systolic blood pressure (SBP) is tightly controlled in older multimorbid patients, because of their frequent exclusion in trials. We assessed the association of hypertension treatment deintensification or intensification with clinical outcomes in older adults with tightly controlled SBP.

DESIGN: Longitudinal cohort study (2011-2013) with 9-month follow-up.

SETTING: U.S.-nationwide primary care Veterans Health Administration healthcare system.

PARTICIPANTS: Veterans aged 65 and older with baseline SBP <130 mmHg and ≥1 antihypertensive medication during ≥2 consecutive visits (N = 228,753).

EXPOSURE: Deintensification or intensification, compared with stable treatment.

MAIN OUTCOMES AND MEASURES: Cardiovascular events, syncope, or fall injury, as composite and distinct outcomes, within 9 months after exposure. Adjusted logistic regression and inverse probability of treatment weighting (IPTW, sensitivity analysis).

RESULTS: Among 228,753 patients (mean age 75 [SD 7.5] years), the composite outcome occurred in 11,982/93,793 (12.8%) patients with stable treatment, 14,768/72,672 (20.3%) with deintensification, and 11,821/62,288 (19.0%) with intensification. Adjusted absolute outcome risk (95% confidence interval) was higher for deintensification (18.3% [18.1%-18.6%]) and intensification (18.7% [18.4%-19.0%]), compared with stable treatment (14.8% [14.6%-15.0%]), p < 0.001 for both effects in the multivariable model). Deintensification was associated with fewer cardiovascular events than intensification. At baseline SBP <95 mmHg, cardiovascular event risk was similar for deintensification and stable treatment, and fall risk lower for deintensification than intensification. IPTW yielded similar results. Mean follow-up SBP was 124.1 mmHg for stable treatment, 125.1 mmHg after deintensification (p < 0.001), and 124.0 mmHg after intensification (p < 0.001).

CONCLUSION: Antihypertensive treatment deintensification in older patients with tightly controlled SBP was associated with worse outcomes than continuing same treatment intensity. Given higher mortality among patients with treatment modification, confounding by indication may not have been fully corrected by advanced statistical methods for observational data analysis.

PMID:34097300 | DOI:10.1111/jgs.17295

Sports Med. 2021 Jun 7. doi: 10.1007/s40279-021-01486-x. Online ahead of print.

ABSTRACT

BACKGROUND: The relationship between exercise-induced muscle damage (EIMD) indicators and acute training loads (TL) is yet to be reviewed extensively in semi-elite and elite athlete populations.

OBJECTIVES: The objectives of this systematic review and meta-analysis were threefold: (1) to evaluate studies of EIMD following the initial period of the preseason in semi-elite and elite athletes: (2) to examine acute physiological and performance responses across two periods of the season with similar TL; and (3) to examine acute physiological and performance responses to acute changes in TL during the season.

METHODS: The CINAHL, PubMed, Scopus, SPORTDiscus and Web of Science databases were systematically searched for studies that investigated: (1) semi-elite or elite athletes in team or individual sports following a periodised training programme; and (2) measured acute responses to training. Studies were excluded if: (1) conducted in animals; (2) non-English language; or (3) a conference abstract, review or case report. The Kmet Quality Scoring of Quantitative Studies tool was used for study appraisal.

SYNTHESIS METHODS: Data were quantitatively analysed by generating forest plots to report test statistics for statistical significance and inter-trial heterogeneity.

RESULTS: Of the included studies (n = 32), athletes experienced greater creatine kinase (CK) concentrations (Z = 4.99, p < 0.00001, I² = 74%), inflammatory factors and other indirect measures of muscle damage in the initial phase of the preseason period compared to the off-season; there were no changes in CK (Z = 1.43, p = 0.15, I² = 74%) across two time points of similar TL; and there were concurrent increases in CK with increases in TL (Z = 4.26, p < 0.0001, I² = 36%) and vice versa (Z = 4.33, p < 0.0001, I² = 79%).The qualitative analysis identified that the response of inflammatory factors and other indirect measures of muscle damage to changes in load were inconclusive.

LIMITATIONS: This review included varying age, sex, sports and competition levels. The group level meta-analysis failed to identify within-athlete or position-specific differences across time.

CONCLUSION: Blood biomarkers of EIMD may not differ across periods of similar TL, however can be considered a sensitive monitoring tool for assessing responses following acute TL changes in semi-elite and elite athletes.

PMID:34097298 | DOI:10.1007/s40279-021-01486-x

Methods Mol Biol. 2021;2326:167-195. doi: 10.1007/978-1-0716-1514-0_12.

ABSTRACT

Environmental epidemiology is a science that applies traditional epidemiology methods and combines the characteristics of the relationship between environment and population health, and studies the relationship between external environmental factors and population health from a macro perspective. The following methods are usually used. (1) Descriptive research: including ecological research and current situation research. (2) Analytical research: including case-control research and group research. (3) Experimental epidemiological research. In this section, according to the short-term and long-term effects of studying environmental risk factors, it is divided into two parts. Short-term effect methods include time series study, case-crossover study, and panel study. Long-term effect methods include cross-sectional study, case-control study, and cohort study.

PMID:34097268 | DOI:10.1007/978-1-0716-1514-0_12

Obes Surg. 2021 Jun 7. doi: 10.1007/s11695-021-05455-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of the OAGB at least 10 years after surgery.

MATERIAL AND METHODS: We retrospectively reviewed our prospectively collected data on consecutive morbid patients with obesity receiving OAGB from January 2005 to December 2007.

RESULTS: A total of 385 patients met the inclusion criteria. The mean follow-up was 149 months. Of all patients, 52% underwent OAGB as a primary procedure and 48% as a revisional procedure. At the 10-year follow-up, the mean body mass index (BMI) was 30.7 ± 11.8, the mean %TWL was 33.4 ± 10.6, and the mean %EWL was 64.1 ± 24.6. We did not find a significant statistical difference in terms of weight loss between primary OAGB and secondary OAGB. In total, 43% of patients achieved a %EWL greater than 75%, while 29% of the patients had an EWL% that was below 50%. All of the comorbidities related to obesity showed a high improvement or fully resolved. Early complications occurred in 9 patients (2.3%), while the overall rate of late complications was 17.1%. Nineteen patients (4.9%) developed an ulcer at the gastrojejunal anastomosis level, nine patients (2.3%) were re-hospitalized for major malnutrition, thirty-eight patients (9.8%) showed a postoperative biliary reflux, and five patients (2.7%) experienced severe anemia, which required several hospitalizations for iron I.V. supplementation.

CONCLUSION: According to results of the present study, we believe that OAGB has shown to be a technique with a reasonable balance between long-term efficacy and undesirable sequelae.

PMID:34097238 | DOI:10.1007/s11695-021-05455-1

Environ Sci Pollut Res Int. 2021 Jun 7. doi: 10.1007/s11356-021-14732-6. Online ahead of print.

ABSTRACT

This paper investigates the dynamic short-term and long-term relationships among real GDP per capita, energy consumption, urbanization, and carbon dioxide emissions within the framework of the environmental Kuznets curve (EKC) hypothesis for Southeastern Europe (SEE) from 1997 to 2014. The evidence highlights an inverted U-shaped nexus between real GDP per capita and carbon dioxide emissions (i.e., the EKC hypothesis is verified in the long-run in the sample as a whole). The short-run estimates provide evidence of inverted U-shaped EKC only for Greece and Moldova. Two-way causal relationship between urbanization and pollutant emission was also established in the short-run, as well as one-way causality flowing from real GDP per capita to pollutant emission. The coefficients with the real GDP per capita and energy consumption are negative and statistically significant in the long-term. These findings indicate the existence of an error correction mechanism that drives the observed variables back to their equilibrium. Moreover, the findings show that the consistent increase in energy consumption has not reduced environmental pressures.

PMID:34097219 | DOI:10.1007/s11356-021-14732-6

Mol Biol Rep. 2021 Jun 7. doi: 10.1007/s11033-021-06470-2. Online ahead of print.

ABSTRACT

Genome-wide association studies have paved the way for the discovery of new markers regarding many diseases, including male infertility. A previous study on Caucasians highlighted 172 polymorphisms for their putative association with male infertility and we attempted to replicate these findings on our dataset comprising of Greek male individuals (n = 360). We retrieved 59 out of 172 polymorphisms and tested for all association models on 278 normospermic men and 82 patients with an abnormal seminogram, later separated into oligozoospermic and asthenozoospermic groups. Our findings indicate that two SNPs (rs2296225 in KIF17, rs7224496 in SMYD4) are associated with male infertility in the Greek population and have not been recorded in literature as of yet. These novel markers need further validation via additional studies and an increased individual number. All in all, replication studies, possess the power to validate existing polymorphisms found across all population and thus increase both statistical significance as well as identify novel potentially diagnostic markers.

PMID:34097203 | DOI:10.1007/s11033-021-06470-2

Psychometrika. 2021 Jun 7. doi: 10.1007/s11336-021-09771-4. Online ahead of print.

ABSTRACT

The model-implied instrumental variable (MIIV) estimator is an equation-by-equation estimator of structural equation models that is more robust to structural misspecifications than full information estimators. Previous studies have concentrated on endogenous variables that are all continuous (MIIV-2SLS) or all ordinal . We develop a unified MIIV approach that applies to a mixture of binary, ordinal, censored, or continuous endogenous observed variables. We include estimates of factor loadings, regression coefficients, variances, and covariances along with their asymptotic standard errors. In addition, we create new goodness of fit tests of the model and overidentification tests of single equations. Our simulation study shows that the proposed MIIV approach is more robust to structural misspecifications than diagonally weighted least squares (DWLS) and that both the goodness of fit model tests and the overidentification equations tests can detect structural misspecifications. We also find that the bias in asymptotic standard errors for the MIIV estimators of factor loadings and regression coefficients are often lower than the DWLS ones, though the differences are small in large samples. Our analysis shows that scaling indicators with low reliability can adversely affect the MIIV estimators. Also, using a small subset of MIIVs reduces small sample bias of coefficient estimates, but can lower the power of overidentification tests of equations.

PMID:34097200 | DOI:10.1007/s11336-021-09771-4

Gen Thorac Cardiovasc Surg. 2021 Jun 7. doi: 10.1007/s11748-021-01663-9. Online ahead of print.

ABSTRACT

OBJECTIVES: Controversy exists regarding the justification of primary surgery in primary spontaneous pneumothorax, and surgery is not free from recurrence. We hypothesized that surgery is a risk factor for contralateral recurrence pneumothorax in adolescent.

METHODS: We performed a retrospective cohort study of 163 adolescent with pneumothorax who were treated conservatively with chest tube (n = 100) or chest tube followed by video-assisted thoracoscopic surgery (n = 63) from January 2009 through December 2017.

RESULTS: Ipsilateral recurrence was significantly more common following conservative treatment than surgical treatment (25.0 vs. 3.2%, P < 0.001), while contralateral recurrence was more common in the surgical group than in the conservative group (15.9 vs. 6.0%, P = 0.039). The rates of second episode pneumothorax did not significantly differ between the two treatment groups (P = 0.092). Univariate analysis identified that patients who were treated conservatively had greater risk of ipsilateral recurrence (P = 0.002), while those who proceeded to surgery had greater risk of contralateral recurrence (P = 0.046). No predictors for second episode pneumothorax were found.

CONCLUSION: To avoid over treatment, we recommend that conservative treatment should be the superior option and CT scan should not be a routine examination in adolescent with their first episode of PSP.

PMID:34097199 | DOI:10.1007/s11748-021-01663-9

Hernia. 2021 Jun 7. doi: 10.1007/s10029-021-02431-7. Online ahead of print.

ABSTRACT

PURPOSE: Laparoscopic totally extraperitoneal hernia repair (TEP) is a widely used treatment for inguinal hernia. Single-incision laparoscopic TEP (SILTEP) has attracted the attention of several surgeons, given its superior cosmetic results and patient satisfaction, as well as comparable outcomes to multiport surgery. Nonetheless, no relevant studies have evaluated the learning curve (LC) of SILTEP in terms of both operation time (OT) and surgical failure. Therefore, we aimed to investigate the LC of SILTEP for inguinal hernia.

METHODS: Medical records of 180 patients who underwent SILTEP performed by a single surgeon from a single institution between October 2012 and November 2017 were retrospectively reviewed. The LC was analyzed using the moving average method and cumulative sum control chart (CUSUM) for OT and surgical failure. Surgical failure was defined as the need for additional ports, open conversion, severe postoperative complications (Clavien-Dindo ≥ IIIa), and recurrence. Eight patients who underwent combined surgery or bilateral hernia repair were excluded from the OT analysis.

RESULTS: From CUSUM graphs, the study period was divided into three phases: OT-phases 1 (1st-32nd), 2 (33rd-83rd), and 3 (84th-172nd) for OT and failure-phases 1 (1st-29th), 2 (30th-58th), and 3 (59th-180th) for surgical failure. Mean OTs were statistically different in the three OT phases (64.6 vs. 50.8 vs. 35.2 min; p < 0.001). Open conversion (31.0% vs. 0% vs. 2.5%) and additional port insertion (6.9% vs. 24.1% vs. 2.5%) stabilized consecutively at failure-phases 2 and 3 (p < 0.001). Surgical failure rates decreased to 5.7% by failure-phase 3 (37.9% vs. 24.1% vs. 5.7%; p < 0.001).

CONCLUSION: For an experienced laparoscopic surgeon, we estimated that approximately 60 cases are needed to overcome the LC for SILTEP in terms of both reducing OT and achieving a surgical failure rate < 10%. Further proficiency could be achieved after approximately 85 SILTEP procedures with a stable OT of approximately 35 min.

PMID:34097186 | DOI:10.1007/s10029-021-02431-7