Nevin Manimala

Eur J Ophthalmol. 2024 Mar 27:11206721241243105. doi: 10.1177/11206721241243105. Online ahead of print.

ABSTRACT

PURPOSE: To assess the effect of Glaucoma awareness, knowledge, and anxiety on patients under visual field analysis by Humphrey’s visual field analyzer (HFA) and optical coherence tomography(OCT).

METHODS: This prospective comparative cohort study included glaucoma patients undergoing HFA (Group A)(n = 150) and OCT(Group B) (n = 150). Each group consisted of 75 newly diagnosed patients and 75 patients who were on follow-up. Participants completed State trait anxiety inventory form Y2(STAI) before and after the test to assess pre-test and intra-test anxiety. Another validated and structured questionnaire was used to assess patient awareness and knowledge of glaucoma. Anxiety scores were used to make correlations and comparisons between the two groups and also against visual field reliability indices. The impact of awareness on anxiety scores and its correlation with reliability indices were also determined.

RESULTS: Overall pretest and intratest anxiety scores in patients undergoing HFA were 52.39(9.5) and 52.45(8.6)and OCT 53.04(8.0) and 53.83(8.2) respectively.Pretest anxiety was less in follow-up patients of both groups(Group A-51.04,Group B-52.72).There was no statistically significant difference between the groups(pretest p = 0.52,Intratest p = 0.15). Anxiety score was found to be significantly high in female participants(54.07,p = 0.01)and those without awareness(p < 0.001). Patients with education of graduation and above in group B had significantly lower anxiety scores(p = 0.007).

CONCLUSION: Anxiety levels induced by both diagnostic modalities HFA and OCT appear to be similar and it does not affect the reliability indices.Anxiety score was higher in female participants and participants lacking disease awareness.

PMID:38533557 | DOI:10.1177/11206721241243105

J Clin Nurs. 2024 Mar 27. doi: 10.1111/jocn.17147. Online ahead of print.

ABSTRACT

AIM: To understand the factors that contribute to the risk of suicide among lesbian, gay, bisexual, transgender, queer, intersex and asexual (sexual minorities) youth.

BACKGROUND: The increase in the likelihood of suicide has made it an urgent issue in public health, particularly among young people, where it now ranks as the fourth leading cause of death. This issue becomes even more significant when focusing on sexual minorities.

METHODS: A cross-sectional study was performed in targeted young individuals (15-29 years). Several variables were assessed, including suicide risk, self-esteem, presence and severity of depressive symptoms, perceived social support and self-reported levels of anxiety and depression.

RESULTS: Statistically significant disparities were observed in suicide risk, presence of depressive symptoms and self-reported levels of anxiety and depression, all of which were more pronounced in sexual minority youth compared to heterosexual cisgender individuals. Likewise, statistically significant differences were noted concerning self-esteem and family support, both of which were lower in sexual minority youth.

CONCLUSION: This study has identified risk factors, such as anxiety, depression and limited social support, as well as protective factors, like higher self-esteem and self-concept. Understanding and addressing all these factors are essential in reducing the elevated rates of suicide among sexual minority youth. Consequently, evidence-based interventions such as Gender and Sexuality Alliances, which empower and create safe spaces for sexual minority youth, possess substantial potential for effectively addressing this issue.

IMPLICATIONS FOR THE PROFESSION: Given sexual minorities vulnerability, healthcare pros, especially nurses, must grasp suicide risk factors. They can help by educating, offering care, assessing risk and fighting stigma. This guarantees safety and access to mental health services for at-risk individuals from sexual minorities.

REPORTING METHOD: The reporting follows the STROBE checklist.

PATIENT CONTRIBUTION: People who were invited to participate voluntarily completed a range of questionnaires.

PMID:38533544 | DOI:10.1111/jocn.17147

J Cachexia Sarcopenia Muscle. 2024 Mar 27. doi: 10.1002/jcsm.13458. Online ahead of print.

ABSTRACT

BACKGROUND: Cachexia is prevalent in gastrointestinal cancers and worsens patient outcomes and chemotherapy compliance. We examined to what extent registered gastrointestinal cancer chemotherapy clinical trials record measures and related symptoms of cachexia as outcomes, and whether these were associated with trial characteristics.

METHODS: Four public trial registries (2012-2022) were accessed for Phase II and/or III randomized controlled pancreatic, gastric, and colorectal cancer chemotherapy trial protocols. Trial outcome measures of overall survival and toxicity/side effects, and those related to cachexia [physical activity, weight/body mass index (BMI), dietary limitations, caloric intake, lean muscle mass] and symptoms (appetite loss, diarrhoea, pain, fatigue/insomnia, constipation, nausea, vomiting, and oral mucositis) were extracted, along with the number and types of performance status and patient-reported outcomes (PROs) tools. Data were summarized descriptively. Chi-square tests examined associations between outcomes and trial characteristics (cancer type, trial location, funding source, PROs tools, and commencement year). Statistical significance was set at P < 0.05.

RESULTS: We included 540 trial protocols (pancreatic (35.2%), colorectal (33.3%) and gastric (31.5%)), with most trials from Europe (44.1%). Trial lead investigator was from academia (28.3%), industry (27.6%) and government (26.3%). Allied health professional involvement (26.9%) occurred at eligibility. Adjuvant therapy in trials was mainly treatment-related (68.1%). Additional medication included anti-nausea (2.2%) and analgesia (0.9%). Trial protocols mostly recorded overall survival (90.4%) and toxicity (78.9%), and the symptoms appetite loss (26.1%) and diarrhoea (19.1%), with the other symptoms recorded in <10% of the trials. Reporting of physical activity (P = 0.001), dietary limitations (P = 0.002), lean muscle mass (P = 0.027), appetite loss (P < 0.001), pain (P = 0.001), nausea (P = 0.012), and oral mucositis (P = 0.049) varied depending cancer type. Toxicity/side effects (P = 0.022), physical activity (P < 0.001), appetite loss, nausea, and vomiting (all P < 0.001), diarrhoea (P = 0.010), pain (P = 0.001), fatigue/insomnia (P = 0.001) varied depending on the trial location. Trial funding was predominantly from private/industry (34.3%) and influenced the reporting of overall survival (P = 0.049), weight/BMI (P = 0.005), caloric intake (P = 0.015), and pain (P = 0.031). Performance status and PROs tools were mentioned in 91.2% and 46.3% of the trials, respectively. Trials that incorporated PROs tools were more likely to report cachexia related outcomes, except for overall survival, lean muscle mass, and oral mucositis. The proportion of trials measuring weight/BMI increased with trial commencement year (P = 0.04).

CONCLUSIONS: Cachexia-related outcomes were under-recorded in gastrointestinal cancer chemotherapy trials. As trial patients experience a high symptom burden, cachexia-relevant measures and symptoms should be assessed throughout the trial, and integrated with primary endpoints to support their progress.

PMID:38533530 | DOI:10.1002/jcsm.13458

Int J Womens Health. 2024 Mar 22;16:509-518. doi: 10.2147/IJWH.S453857. eCollection 2024.

ABSTRACT

BACKGROUND: This study aimed to explore the current knowledge level of breast cancer among rural women in Southwest China and analyze the influencing factors of breast cancer cognition.

METHODS: From May to November 2022, 1468 rural women were invited to participate in this study. Demographic information and the Chinese version of the Breast Cancer Awareness Measure (C-BCAM) were collected through one-on-one investigations. The data were analyzed using descriptive statistics, chi-square tests, and multiple regression analysis in SPSS 26.0.

RESULTS: The study included a total of 1468 rural women with a median age of 54.0 (IQR, 47.0, 60.0).The average score of breast cancer in the study population was 73.0 (IQR, 66.0, 82.0). Among women in Southwest China, the awareness rates of knowledge on breast cancer symptoms, barriers to seeking medical help, and risk factors were 68.8%, 98.4%, and 62.1%, respectively. The awareness rate was found to increase with higher education levels (P<0.001) and decrease with increasing age (P<0.001). Multivariate logistic regression analysis identified three variables that might influence breast cancer awareness: education level, contraceptive measures, and history of breast disease (all P<0.05). Specifically, history of breast disease (Odds ratio (OR) = 1.907, 95% CI = 1.128 ~ 3.223), middle school education (OR = 2.155, 95% CI = 1.585 ~ 2.928), and junior college education and above (OR = 5.536, 95% CI = 1.898 ~ 16.148) were positive factors for women’s breast cancer awareness. Conversely, the use of intrauterine devices (OR = 0.523, 95% CI = 0.384 ~ 0.712) was found to be a negative factor for women’s breast cancer awareness.

CONCLUSION: This study highlights the insufficient awareness of breast cancer among women in rural area of Southwest China. It emphasizes the necessity of health education to improve female breast cancer awareness.

PMID:38533523 | PMC:PMC10964776 | DOI:10.2147/IJWH.S453857

Contemp Clin Trials Commun. 2024 Feb 29;38:101282. doi: 10.1016/j.conctc.2024.101282. eCollection 2024 Apr.

ABSTRACT

Studying individual causal effects of health interventions is important whenever intervention effects are heterogeneous between study participants. Conducting N-of-1 trials, which are single-person randomized controlled trials, is the gold standard for their analysis. As an alternative method, we propose to re-analyze existing population-level studies as N-of-1 trials, and use gait as a use case for illustration. Gait data were collected from 16 young and healthy participants under fatigued and non-fatigued, as well as under single-task (only walking) and dual-task (walking while performing a cognitive task) conditions. As a reference to the N-of-1 trials approach, we first computed standard population-level ANOVA models to evaluate differences in gait parameters (stride length and stride time) across conditions. Then, we estimated the effect of the interventions on gait parameters on the individual level through Bayesian repeated-measures models, viewing each participant as their own trial, and compared the results. The results illustrated that while few overall population-level effects were visible, individual-level analyses revealed differences between participants. Baseline values of the gait parameters varied largely among all participants, and the effects of fatigue and cognitive task were also heterogeneous, with some individuals showing effects in opposite directions. These differences between population-level and individual-level analyses were more pronounced for the fatigue intervention compared to the cognitive task intervention. Following our empirical analysis, we discuss re-analyzing population studies through the lens of N-of-1 trials more generally and highlight important considerations and requirements. Our work encourages future studies to investigate individual effects using population-level data.

PMID:38533473 | PMC:PMC10964044 | DOI:10.1016/j.conctc.2024.101282

Front Artif Intell. 2024 Mar 12;7:1326488. doi: 10.3389/frai.2024.1326488. eCollection 2024.

ABSTRACT

The well-known Greulich and Pyle (GP) method of bone age assessment (BAA) relies on comparing a hand X-ray against templates of discrete maturity classes collected in an atlas. Automated methods have recently shown great success with BAA, especially using deep learning. In this perspective, we first review the success and limitations of various automated BAA methods. We then offer a novel hypothesis: When networks predict bone age that is not aligned with a GP reference class, it is not simply statistical error (although there is that as well); they are picking up nuances in the hand X-ray that lie “outside that class.” In other words, trained networks predict distributions around classes. This raises a natural question: How can we further understand the reasons for a prediction to deviate from the nominal class age? We claim that segmental aging, that is, ratings based on characteristic bone groups can be used to qualify predictions. This so-called segmental GP method has excellent properties: It can not only help identify differential maturity in the hand but also provide a systematic way to extend the use of the current GP atlas to various other populations.

PMID:38533467 | PMC:PMC10963464 | DOI:10.3389/frai.2024.1326488

Front Sociol. 2024 Mar 12;9:1194597. doi: 10.3389/fsoc.2024.1194597. eCollection 2024.

ABSTRACT

Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of self-reinforcing dysfunctional behavior characterized by continuous flawed decision making, myopic single-minded focus on one (set of) solution(s), denial, distrust, micromanagement, dogmatic thinking and learned helplessness. We propose the term Death Spiral Effect to describe this difficult-to-break downward spiral of societal decline. Specifically, in the current theory-building review we aim to: (a) more clearly define and describe the Death Spiral Effect; (b) model the downward spiral of societal decline as well as an upward spiral; (c) describe how and why individuals, groups and even society at large might be caught up in a Death Spiral; and (d) offer a positive way forward in terms of evidence-based solutions to escape the Death Spiral Effect. Management theory hints on the occurrence of this phenomenon and offers turn-around leadership as solution. On a societal level strengthening of democracy may be important. Prior research indicates that historically, two key factors trigger this type of societal decline: rising inequalities creating an upper layer of elites and a lower layer of masses; and dwindling (access to) resources. Historical key markers of societal decline are a steep increase in inequalities, government overreach, over-integration (interdependencies in networks) and a rapidly decreasing trust in institutions and resulting collapse of legitimacy. Important issues that we aim to shed light on are the behavioral underpinnings of decline, as well as the question if and how societal decline can be reversed. We explore the extension of these theories from the company/organization level to the society level, and make use of insights from both micro-, meso-, and macro-level theories (e.g., Complex Adaptive Systems and collapsology, the study of the risks of collapse of industrial civilization) to explain this process of societal demise. Our review furthermore draws on theories such as Social Safety Theory, Conservation of Resources Theory, and management theories that describe the decline and fall of groups, companies and societies, as well as offer ways to reverse this trend.

PMID:38533441 | PMC:PMC10964949 | DOI:10.3389/fsoc.2024.1194597

Front Neurol. 2024 Mar 12;15:1344000. doi: 10.3389/fneur.2024.1344000. eCollection 2024.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the SpO₂ (transcutaneous oxygen saturation) -mortality link in elderly T2DM (diabetes mellitus type 2) patients with cerebral infarction and identify their optimal SpO₂ range.

METHODS: In this investigation, we employed a comprehensive approach. Initially, we screened the MIMIC-IV database, identifying elderly T2DM patients with cerebral infarction, utilizing specific ICD-9 and ICD-10 codes. We then harnessed the power of restricted cubic splines to craft a visual representation of the correlation between SpO₂ and 1-year mortality. To enhance our analysis, we harnessed Cox multivariate regression, allowing us to compute adjusted hazard ratios (HR) accompanied by 95% confidence intervals (CIs). Additionally, we crafted Cumulative Mortality Curve analyses, augmenting our study by engaging in rigorous subgroup analyses, stratifying our observations based on pertinent covariates.

RESULTS: In this study, 448 elderly T2DM patients with cerebral infarction were included. Within 1-year post-discharge, 161 patients (35.94%) succumbed. Employing Restricted Cubic Spline analysis, a statistically significant U-shaped non-linear relationship between admission ICU SpO₂ levels and 1-year mortality was observed (P-value < 0.05). Further analysis indicated that both low and high SpO₂ levels increased the mortality risk. Cox multivariate regression analysis, adjusting for potential confounding factors, confirmed the association of low (≤94.5%) and high SpO₂ levels (96.5-98.5%) with elevated 1-year mortality risk, particularly notably high SpO₂ levels (>98.5%) [HR = 2.06, 95% CI: 1.29-3.29, P-value = 0.002]. The cumulative mortality curves revealed the following SpO₂ subgroups from high to low cumulative mortality at the 365th day: normal levels (94.5% < SpO₂ ≤ 96.5%), low levels (SpO₂ ≤ 94.5%), high levels (96.5% < SpO₂ ≤ 98.5%), and notably high levels (>98.5%). Subgroup analysis demonstrated no significant interaction between SpO₂ and grouping variables, including Sex, Age, Congestive heart failure, Temperature, and ICU length of stay (LOS-ICU; P-values for interaction were >0.05).

CONCLUSIONS: Striking an optimal balance is paramount, as fixating solely on lower SpO₂ limits or neglecting high SpO₂ levels may contribute to increased mortality rates. To mitigate mortality risk in elderly T2DM patients with cerebral infarction, we recommend maintaining SpO₂ levels within the range of 94.5-96.5%.

PMID:38533418 | PMC:PMC10964770 | DOI:10.3389/fneur.2024.1344000

Front Plant Sci. 2024 Mar 12;15:1331443. doi: 10.3389/fpls.2024.1331443. eCollection 2024.

ABSTRACT

Plants interact with complex microbial communities in which microorganisms play different roles in plant development and health. While certain microorganisms may cause disease, others promote nutrient uptake and resistance to stresses through a variety of mechanisms. Developing plant protection measures requires a deeper comprehension of the factors that influence multitrophic interactions and the organization of phyllospheric communities. High-throughput sequencing was used in this work to investigate the effects of climate variables and bacterial wildfire disease on the bacterial community’s composition and assembly in the phyllosphere of tobacco (Nicotiana tabacum L.). The samples from June (M1), July (M2), August (M3), and September (M4) formed statistically separate clusters. The assembly of the whole bacterial population was mostly influenced by stochastic processes. PICRUSt2 predictions revealed genes enriched in the M3, a period when the plant wildfire disease index reached climax, were associated with the development of the wildfire disease (secretion of virulence factor), the enhanced metabolic capacity and environmental adaption. The M3 and M4 microbial communities have more intricate molecular ecological networks (MENs), bursting with interconnections within a densely networked bacterial population. The relative abundances of plant-beneficial and antagonistic microbes Clostridiales, Bacillales, Lactobacillales, and Sphingobacteriales, showed significant decrease in severally diseased sample (M3) compared to the pre-diseased samples (M1/M2). Following the results of MENs, we further test if the correlating bacterial pairs within the MEN have the possibility to share functional genes and we have unraveled 139 entries of such horizontal gene transfer (HGT) events, highlighting the significance of HGT in shaping the adaptive traits of plant-associated bacteria across the MENs, particularly in relation to host colonization and pathogenicity.

PMID:38533399 | PMC:PMC10963427 | DOI:10.3389/fpls.2024.1331443

Postepy Dermatol Alergol. 2024 Feb;41(1):20-31. doi: 10.5114/ada.2023.135619. Epub 2024 Feb 28.

ABSTRACT

INTRODUCTION: Glutathione S-transferase (GST) enzymes play a crucial role in detoxification by catalysing the conjugation of many hydrophobic and electrophilic compounds with reduced glutathione. Polymorphisms in GST genes may influence the susceptibility to various cancers, including melanoma.

AIM: We reported a systematic review and meta-analysis to evaluate the association between GST polymorphisms and susceptibility to cutaneous melanoma.

MATERIAL AND METHODS: A comprehensive search of four databases, namely PubMed, Scopus, Cochrane Library, and Web of Science, was conducted to gather pertinent studies up until 24 August 2023. No restrictions were imposed during the search. The analysis included 32 studies and was broken down into subgroups based on ethnicity, control source, control matching, quality score, and sample size.

RESULTS: The forest plot analyses on GSTM1, GSTT1, combined GSTM1/GSTT1, and GSTP1 polymorphisms in relation to melanoma risk showed no statistically significant differences between the case and control groups, except for the recessive model of GSTP1 polymorphism. The analysis revealed significant associations between GSTM1 polymorphisms and melanoma risk in Asians and in studies with a sample size of less than 200. For the combined GSTM1/GSTT1 polymorphisms, a significant association was found in hospital-based controls.

CONCLUSIONS: While this study enhances our understanding of the genetic factors influencing melanoma risk, it also highlights the need for further research. The current evidence is not sufficient to confirm or reject the intervention effect. Future research should consider gene-gene and gene-environment interactions, which could offer a more comprehensive understanding of the complex biology of melanoma.

PMID:38533372 | PMC:PMC10962381 | DOI:10.5114/ada.2023.135619