Nevin Manimala

Front Med (Lausanne). 2023 Jun 27;10:1159015. doi: 10.3389/fmed.2023.1159015. eCollection 2023.

ABSTRACT

OBJECTIVE: The objective of this study is to determine whether restricted cervical mobility in ankylosing spondylitis (AS) is associated with increased fall frequency or fear of falling.

METHODS: A total of 134 AS patients and 199 age- and gender-matched control subjects (CS) with soft-tissue cervicothoracic pain were prospectively evaluated for fall risk. Subjects were divided into non-fallers, single fallers, and multiple fallers. Dynamic cervical rotations and static cervicothoracic axial measurements were compared between the groups. In total, 88 AS patients were reviewed more than once; Kaplan-Meier plots were constructed for fall risk as a function of cervical rotation amplitudes. Falls Efficacy Scale-International (FES-I) questionnaire measured the fear of falling.

RESULTS: In total, 34% of AS patients and 29% of CS fell (p = 0.271) in the year prior to evaluation. In AS, static anatomical measurements were unrelated to fall occurrence. The trends of multiple AS fallers to greater flexed forward postures and reduced dynamic cervical rotations were not statistically significant. Cervicothoracic pain (p = 0.0459), BASDAI (p = 0.002), and BASFI (p = 0.003) scores were greater in multiple fallers. FES-I scores were greater in fallers (p = 0.004). Of the 88 AS patients reviewed (or seen) on more than one occasion, 46.5% fell over the 9-year observation period, including all multiple fallers and 71.4% of single fallers. Survival curves showed increased fall risk as cervical rotational amplitudes decreased.

CONCLUSION: In AS, decreased cervical rotations increase fall risk and fear of falling. In multiple fallers, falls were associated with greater disease activity. Cervical muscle stiffness in AS may cause non-veridical proprioceptive inputs and contribute to increased fall frequency similar to individuals with soft-tissue cervicothoracic pain.

PMID:37441687 | PMC:PMC10333576 | DOI:10.3389/fmed.2023.1159015

Front Public Health. 2023 Jun 27;11:1170317. doi: 10.3389/fpubh.2023.1170317. eCollection 2023.

ABSTRACT

BACKGROUND: The COVID-19 epidemic has put an enormous strain on the world’s healthcare systems, lifestyles, and quality of life. Ethiopia attempted to meet the myriad needs of its people due to the COVID-19 epidemic and the government has demonstrated a strong commitment in order to lessen the epidemic’s impact on the populace. Despite this fact, the population’s compliance with measures was not as needed.

OBJECTIVES: To assess knowledge, attitude, and practice regarding COVID-19 transmission, prevention, and self-quarantine management among public employees in selected locations of the Sidama Region, Southern Ethiopia, in 2020.

METHODS: An institution-based cross-sectional study was conducted from 01 October to 30 October 2020, among 399 public servants in selected locations of the Sidama Region, Sothern Ethiopia. One-stage cluster sampling was used to randomly select 16 public service sector offices from the total 32 sector offices in the selected locations of the region. Simple random sampling was employed to select respondents following equal distribution of the samples to 16 sector offices. Data were collected using an adapted self-administered questionnaire. Data entered using EpiData version 3.1 and SPSS version 24 were used for statistical analysis. Descriptive statistics was used to compute frequencies, percentages, and means for independent and dependent variables.

RESULT: Overall, 42.36% of respondents had good knowledge of COVID-19, while the remaining 57.64% had poor knowledge. The percentage of favorable attitudes toward COVID-19 prevention and control were 65.2, 54.4% of respondents had a good level of practice of COVID-19 preventive and control measures, and 52.4% of the respondents had a good level of knowledge regarding self-quarantine management.

CONCLUSION: The level of knowledge, attitude, practice, and self-quarantine management in the area is insufficient for preventing and controlling the disease. Evidence-based awareness creation and law enforcement in the study areas and surroundings, with an emphasis on infection prevention and control (IPC) in the public sector and other public gathering areas, is recommended.

PMID:37441644 | PMC:PMC10335795 | DOI:10.3389/fpubh.2023.1170317

Front Public Health. 2023 Jun 27;11:1163867. doi: 10.3389/fpubh.2023.1163867. eCollection 2023.

ABSTRACT

AIMS: This study aimed to explore the dyadic effects of depression and anxiety on insomnia symptoms in Chinese older adults and their caregivers living in a community setting.

METHODS: Data were collected from 1,507 pairs of older adults and their caregivers who were in the Guangdong Mental Health Survey in China. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder module 7 (GAD-7), and Insomnia Severity Index (ISI) were used to measure depression, anxiety, and insomnia symptoms. Actor-Partner Interdependence Models (APIM) were used to determine whether anxiety or depression symptoms predicted individual or dyadic insomnia.

RESULTS: Older adults’ and caregivers’ depression and anxiety had significant positive correlations with their own and their caregivers’ insomnia symptoms (all P < 0.001). Actor effects were found between depression and insomnia symptoms in both older adults and caregivers (B = 0.695, P < 0.001; B = 0.547, P < 0.001, respectively), with one significant partner effects (B = 0.080, P = 0.007). Actor effects were also found between anxiety and insomnia symptoms in both older adults and caregivers (B = 0.825, P < 0.001; B = 0.751, P < 0.001, respectively), with one significant partner effects (B = 0.097, P = 0.004). However, the caregivers’ depression and anxiety were not associated with older adults’ insomnia symptoms in the APIM analyses.

CONCLUSIONS: Older adults and their caregivers had an interrelationship between psychological distress and insomnia. Consequently, healthcare providers might consider involving dyads when designing programs to reduce insomnia and improve psychological distress for family caregivers.

PMID:37441638 | PMC:PMC10333500 | DOI:10.3389/fpubh.2023.1163867

Data Brief. 2023 Jun 14;49:109314. doi: 10.1016/j.dib.2023.109314. eCollection 2023 Aug.

ABSTRACT

This article describes data related to the research paper entitled “Concurrent vs. retrospective temporal data collection: Attack-evolution-finish as a simplification of Temporal Dominance of Sensations?” [1]. Temporal sensory perception data of five dark chocolates that vary in cocoa content were collected from 129 consumers who evaluated the samples in two sessions, using a different sensory evaluation method in each session. A within-subject design was set-up to compare the two data collection methods: consumers in Panel 1 (36 men and 32 women aged 19 to 63 years old) started with the Temporal Dominance of Sensations (TDS) method, and consumers in Panel 2 (35 men and 26 women aged 19 to 61 years old) started with the Attack-Evolution-Finish dominance (AEF-D) method. For each chocolate, consumers had to report the sensations they perceived either concurrently (TDS) or retrospectively (AEF-D) to the tasting. After the descriptive task, consumers were asked to rate their liking for chocolates on a 9-point discrete scale. Finally, consumers had to answer questions related to the difficulty of the descriptive task. The dataset includes information on consumers’ gender, age and frequency of consumption of dark chocolates. The dataset can be reused by sensometricians to compare methods or develop new statistical models for data analysis. It can also be reused to compare at the individual level declarative sensory measures collected either concurrently or retrospectively to tasting. Thus, the impact of cognition (due to memorization, stress or complexity of measurements) on sensory description and liking can be investigated. More specifically, this dataset can be help understand how the dynamics of perception of texture, mouthfeel and flavour attributes are integrated when using static measures.

PMID:37441628 | PMC:PMC10333425 | DOI:10.1016/j.dib.2023.109314

Ther Adv Ophthalmol. 2023 Jun 30;15:25158414231180985. doi: 10.1177/25158414231180985. eCollection 2023 Jan-Dec.

ABSTRACT

BACKGROUND: Obesity affects microvascular structures. The effect of obesity on the ocular vascular system can be evaluated by changes in the choroidal thickness (CT) and retrobulbar blood flow (RBF).

OBJECTIVES: To evaluate the CT and RBF parameters in obese patients with various body mass index (BMI) values and compare these parameters with normal weight, healthy subjects.

DESIGN: A prospective study.

METHODS: The study included 102 eyes of 102 female patients. Patients were divided into three groups according to BMI as group 1 with a BMI of 18.5-24.99 (n = 32), normal weight group; group 2 with a BMI of 30-34.99 (n = 35), as obese class I; and group 3 with a BMI of 35-39.99 (n = 35), as obese class II. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index, and pulsatility index values of the central retinal artery (CRA) and ophthalmic artery (OA) were evaluated with color Doppler ultrasonography. CT was measured at the subfoveal area and at 500-µm intervals nasal and temporal to the fovea up to a distance of 1500 µm by using the enhanced depth imaging technique of optical coherence tomography. Intraocular pressure (IOP) was measured with a Goldmann applanation tonometry.

RESULTS: There was a significant difference in IOP values within the groups with the highest values in group 3 (17.6 ± 2.1 mmHg) and the lowest in group 1 (12.4 ± 1.7 mmHg). The CT in groups 2 and 3 was found to be statistically significantly lower than that in group 1 at all measurement points (p < 0.001). There was a statistically significant negative correlation between CT at all measurement points and BMI (p < 0.001). The mean CRA PSV, EDV, and OA EDV values were statistically significantly lower in each obese group than those values in group 1 (p < 0.001). The OA PSV values were significantly lower in group 3 (36.5 ± 5.9 cm/s) than those in group 2 (43.8 ± 4 cm/s) and group 1 (44.6 ± 5.2 cm/s) (p < 0.001). Also, significant associations were found between BMI and CRA PSV, CRA EDV, and OA PSV values (p < 0.001).

CONCLUSION: Obesity may predispose to eye pathologies by changing the ocular vascular circulation.

PMID:37441618 | PMC:PMC10333989 | DOI:10.1177/25158414231180985

Front Neurol. 2023 Jun 27;14:1212868. doi: 10.3389/fneur.2023.1212868. eCollection 2023.

ABSTRACT

BACKGROUND: Lymphoplasmapheresis (LPE) is a new therapy developed on the basis of traditional plasma exchange (PE) in combination with leukapheresis. Currently, it remains unclear whether PE and LPE show differences in efficacy for severe MG.

METHODS: A retrospective analysis was conducted on 198 MG patients, 75 in the PE group and 123 in the LPE group, and the patients’ Myasthenia Gravis Foundation of America (MGFA) Clinical Classification was Class IV. The treatment outcome was the change in Quantitative Myasthenia Gravis Score (QMGS) from baseline to the end of treatment. Propensity score matching (PSM) was applied for the balance of confounders between the two groups.

RESULTS: In this study cohort, the safety profile of LPE and PE was good and no serious adverse events were observed. Based on PSM, 62 patients treated with LPE and 62 patients treated with PE were entered into a comparative efficacy analysis. In the PE group, patients underwent a total of 232 replacements, with a mean of 3.74. PE significantly improved the patients’ QMGS performance, with the mean QMGS decreasing from 22.98 ± 4.03 points at baseline to 18.34 ± 5.03 points after treatment, a decrease of 4.68 ± 4.04 points (p < 0.001). A decrease of ≥3 points in QMGS was considered a significant improvement, with a treatment response rate of 67.7% in the PE group. In the LPE group, patients received a total of 117 replacements, with a mean of 1.89. The patients’ mean QMGS was 23.19 ± 4.11 points at baseline and was 16.94 ± 5.78 points after treatment, a decrease of 6.26 ± 4.39 points (p < 0.001). The improvement in QMGS was more significant in patients treated with LPE compared to the PE group (p = 0.039). The treatment response rate in the LPE group was 79%, which was not significantly different compared to the PE group (p = 0.16). The LEP group had a shorter mean length of stay compared to the PE group (10.86 ± 3.96 vs. 12.14 ± 4.14 days), but the difference was not statistically significant (p = 0.13). During the 2-month follow-up period, LPE may be associated with better functional outcomes for patients, with lower QMG score and relapse rate. LPE and PE were both effective in reducing the levels of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and AChR-Ab. Compared to PE, LPE was superior in the reduction of AChR-Ab titer.

CONCLUSION: In severe MG, LPE may be a more preferred treatment option than PE. It achieves treatment outcomes that are not inferior to or even better than PE with fewer replacements. This study provides further evidence to support the application of LPE as a new treatment option for MG.

PMID:37441608 | PMC:PMC10335809 | DOI:10.3389/fneur.2023.1212868

Front Pediatr. 2023 Jun 27;11:1140556. doi: 10.3389/fped.2023.1140556. eCollection 2023.

ABSTRACT

BACKGROUND: Non-pharmaceutical interventions (NPIs), such as social distancing and hand washing, have been associated with a decline in the preterm birth rate worldwide. We aimed to evaluate whether the preterm birth rate in Korea during the coronavirus disease 2019 lockdown has changed compared to that in previous years.

METHOD: A birth registry from the Korea Statistical Information Service, which is a nationwide official database, was used to include all births claimed to have occurred between 2011 and 2020. Newborns with gestational age (GA) less than 22 weeks and birth weight less than 220 g were excluded. The pre-NPI period was designated as January 2011 to January 2020, and the NPI period was defined as February 2020 to December 2020. We assessed the effect of NPI on the incidence of prematurity per 100 births using an interrupted time-series quasi-experimental design and implementing an autoregressive integrated moving average (ARIMA) model.

RESULTS: From 2011 to 2020, a total of 3,931,974 live births were registered, among which 11,416 were excluded. Consequently, the final study population included 3,920,558 live births (both singleton and multiple births) among which 275,009 (7.0%) were preterm. The preterm birth rate was significantly higher during the NPI period (8.68%) compared to that in the pre-NPI period (6.92%) (P < 0.001). The ARIMA model showed that in all singleton and multiple births, except those in July (observed 9.24, expected 8.54, [95% prediction interval {PI} 8.13-8.96], percent difference 7.81%), September (observed 7.89, expected 8.35, [95% PI 7.93-8.76], percent difference -5.66%), and December (observed 9.90, expected 9.40, [95% PI 8.98-9.82], percent difference 5.2%), most observed values were within the 95% PI of the expected values and showed an increasing trend.

CONCLUSION: In this nationwide observational study, the trend in premature birth rate did not significantly change due to NPI implementation in Korea, as it had been increasing since 2011. The trend of Korea’s birth rate appears to be unaffected by the implementation of NPIs; however, further studies with a longer follow-up period are needed.

PMID:37441577 | PMC:PMC10333519 | DOI:10.3389/fped.2023.1140556

Nurs Res. 2023 Jul 11. doi: 10.1097/NNR.0000000000000681. Online ahead of print.

ABSTRACT

BACKGROUND: Little is known about where young adults with chronic illness die in the United States and factors associated with place of death.

OBJECTIVES: This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data.

METHODS: Our sample (N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, dead on arrival) or non-acute care (home, hospice, nursing home/long-term care, other, unknown). Examined factors were sex, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death.

RESULTS: Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years.

DISCUSSION: Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.

PMID:37440265 | DOI:10.1097/NNR.0000000000000681

JAMA Oncol. 2023 Jul 13. doi: 10.1001/jamaoncol.2023.2150. Online ahead of print.

ABSTRACT

IMPORTANCE: In spite of the effectiveness of endocrine therapy plus cyclin-dependent kinase (CDK) 4/6 inhibitors as the first-line treatment for estrogen receptor (ER)-positive, erb-b2 receptor tyrosine kinase 2 (ERBB2 [formerly HER2/neu])-negative (ER+/ERBB2-) metastatic breast cancer (MBC), patients eventually develop resistance, and eventually most will receive chemotherapy. The METEORA-II trial compared a metronomic all-oral treatment with intravenous (IV) chemotherapy.

OBJECTIVE: To compare the efficacy of the oral vinorelbine plus cyclophosphamide plus capecitabine (VEX) regimen vs weekly IV paclitaxel among patients with ER+/ERBB2- MBC who are candidates for chemotherapy.

DESIGN, SETTING, AND PARTICIPANTS: This phase 2 randomized clinical trial including 140 women 18 years and older (randomized 1:1) with ER+/ERBB2- MBC was carried out from September 13, 2017, to January 14, 2021 at 15 centers in Italy. Eligible patients could have received 1 prior line of chemotherapy for MBC and/or 2 lines of endocrine therapy (including CDK4/6 inhibitors).

INTERVENTIONS: In 4-week cycles, patients received either metronomic oral VEX or weekly IV paclitaxel.

MAIN OUTCOMES AND MEASURES: The primary end point was investigator-assessed time to treatment failure (TTF) defined as the interval between the date of randomization to the end of treatment (because of disease progression or lack of tolerability or because further trial treatment was declined). Secondary end points included progression-free survival (PFS), overall survival (OS), and disease control rate (complete or partial response or stable disease lasting for at least 24 weeks).

RESULTS: In total, 133 patients received either VEX (n = 70) or paclitaxel (n = 63) in 4-weekly cycles. The median age was 61 (range, 30-80) years. The VEX treatment significantly prolonged TTF vs paclitaxel (hazard ratio [HR], 0.61; 95% CI, 0.42-0.88; P = .008), median TTF was 8.3 (95% CI, 5.6-11.1) months for VEX vs 5.7 (95% CI, 4.1-6.1) months for paclitaxel, and the 12-month TTF was 34.3% for VEX vs 8.6% for paclitaxel. The median PFS was 11.1 (95% CI, 8.3-13.8) months vs 6.9 (95% CI, 5.4-10.1) months favoring VEX (HR, 0.67; 95% CI, 0.46-0.96, P = .03). The 12-month PFS was 43.5% for VEX vs 21.9% for paclitaxel. No difference in OS was found. The TF event for 55.6% of patients was progression of disease; for 23% it was AEs. More patients assigned to VEX had at least 1 grade 3 or 4 targeted adverse event (VEX, 42.9%; 95% CI, 31.1%-55.3% vs paclitaxel, 28.6%; 95% CI, 17.9%-41.3%), but essentially no alopecia.

CONCLUSION AND RELEVANCE: This randomized clinical trial found significantly prolonged TTF and PFS for oral VEX but no improvement in OS compared with intravenous paclitaxel, despite increased but still manageable toxic effects. The VEX regimen may provide more prolonged disease control than weekly paclitaxel for ER+/ERBB2- MBC.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02954055.

PMID:37440239 | DOI:10.1001/jamaoncol.2023.2150

JAMA Netw Open. 2023 Jul 3;6(7):e2323205. doi: 10.1001/jamanetworkopen.2023.23205.

ABSTRACT

IMPORTANCE: Common mental disorders (CMD), which include depression and anxiety, are prevalent among people living with HIV and are associated with suboptimal antiretroviral therapy (ART) adherence.

OBJECTIVE: To assess the effect of a lay health worker-led psychological intervention on ART adherence, virologic suppression, and mental health symptoms.

DESIGN, SETTING, AND PARTICIPANTS: Open-label pragmatic cluster trial with 1:1 block randomization of 16 health facilities in rural Bikita, Zimbabwe. Recruitment occurred from October 2018 to December 2019, and participants were followed up for 12 months, ending in December 2020. Participants were adults aged 18 years and older, who spoke English or Shona, screened positive for CMD (Shona Symptoms Questionnaire [SSQ]-14 score ≥9), received first-line ART for 6 or more months, had no World Health Organization stage 4 disease, no psychosis, were not pregnant, and provided informed consent. Data were analyzed from March 2021 to February 2022.

INTERVENTION: The Friendship Bench, consisting of 6 lay health worker-led weekly problem-solving therapy sessions and optional peer-led group support.

MAIN OUTCOMES AND MEASURES: The primary outcome was mean adherence during 2 to 6 months of follow-up, and the secondary outcomes were mean adherence during 1 to 12 months of follow-up, change in SSQ-14 and Patient Health Questionnaire (PHQ-9) scores (3, 6, 9, and 12 months), and viral load suppression (6 and 12 months).

RESULTS: A total of 516 participants were recruited (244 in Friendship Bench and 272 in enhanced standard care facilities); 438 (84.9%) were female and the mean (SD) age was 45.6 (10.9) years. Mean (SD) adherence between 2 to 6 months was 89.9% (18.4%) in the Friendship Bench group and 87.2% (20.1%) in the control group. The intervention had no statistically significant effect on adherence between 2 to 6 months (unadjusted mean difference, 1.93 percentage points; 95% CI, -1.20 to 5.06 percentage points; P = .23), between months 1 to 12 (mean difference 0.79 percentage points; 95% CI, -2.14 to 3.71 percentage points; P = .60), or viral suppression. Declines in SSQ-14 scores from baseline to 3 months (difference, -1.65; 95% CI, -3.07 to -0.24), 6 months (difference, -1.57; 95% CI, -2.98 to -0.15), and 9 months (difference, -1.63; 95% CI, -3.05 to -0.22) were greater in the Friendship Bench than the standard care group (P < .05). There were no differences in the decline in the SSQ-14 scores from baseline to 12 months and in declines in PHQ-9 scores from baseline to 3, 6, 9, and 12 months.

CONCLUSIONS AND RELEVANCE: In this randomized trial of HIV-positive participants with CMD, the Friendship Bench intervention had no effect on adherence and viral suppression, possibly due to the absence of skill-based adherence training and a ceiling effect.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03704805.

PMID:37440230 | DOI:10.1001/jamanetworkopen.2023.23205