Nevin Manimala

J Ment Health Policy Econ. 2024 Dec 1;27(4):129-143.

ABSTRACT

BACKGROUND: Persistent depressive disorder (PDD; chronic depression) is associated with high personal, economic, and societal burden. Patients with PDD often fail to respond to treatment, despite long-term, intensive care, suggesting that future treatment should focus more on functional recovery. The “Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder” (PPEP4All-PDD) is a brief self-management program for patients with PDD with nine weekly sessions, provided in group or individual format. Its focus on functional recovery may increase quality of life and shorten treatment duration, thus reducing healthcare and societal costs. This study examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their partners/caregivers compared to care-as-usual (CAU).

AIMS OF THE STUDY: In this economic evaluation, we examined whether a favorable cost-utility of PPEP4All-PDD compared to CAU could be attained.

METHOD: In this multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were included. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life was measured using the EuroQoL 5-Dimensions/Levels (EQ-5D-5L). Cost of healthcare utilization and productivity loss were assessed using the Trimbos questionnaire for Costs associated with Psychiatric illness (TiC-P). We examined incremental costs per quality-adjusted life years (QALYs) after one year.

RESULTS: In relation to PPEP4All-PDD, 62% (n = 23) of patients had no participating PPEP4All-PDD partner/caregiver, and 89% (n = 33) of patients participated in group format. On average, PPEP4All-PDD cost €232 including the PPEP4All-PDD partner/caregiver, or €166 excluding the partner/caregiver. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in QALYs between PPEP4All-PDD and CAU. The probability that PPEP4All-PDD is cost-effective compared to CAU remained below 50% for all acceptable values of willingness-to-pay for a QALY.

DISCUSSION: This was the first economic evaluation of PPEP4All-PDD. Compared to CAU, PPEP4All-PDD did not lead to lower total healthcare costs nor higher quality of life in the one-year follow-up period. PPEP4All-PDD patients continued to receive additional mental healthcare sessions, showing that the process of ending treatment after a self-management intervention is not clear. The COVID-19 situation may have also affected this process after PPEP4All-PDD, due to higher levels of anxiety and loneliness. We could not confirm that involvement of the partner/caregiver was beneficial to patient treatment outcomes and requires further examination.

IMPLICATIONS: This economic evaluation failed to find significant differences in costs between PPEP4All-PDD and CAU over a study period of one year. Non-significant differences were in favor of CAU, leading to a low probability of PPEP4All-PDD being cost- effective. Providing biweekly sessions and extending the follow-up period may be necessary in future studies. Patients with PDD may require more time to learn and integrate self-management practices into their daily life prior to effecting changes in personal quality of life and (mental) healthcare utilization. Digital interventions, such as digital PPEP4All-PDD, with or without the partner/caregiver may be a cost-effective option.

PMID:39931808

J Ment Health Policy Econ. 2024 Dec 1;27(4):115-128.

ABSTRACT

BACKGROUND: With over 40 million food insecure Americans, access to food is a significant policy challenge. Food insecurity is associated with many adverse health conditions, including poorer mental health outcomes. However, previous research generally does not address that poor mental health can both be a cause and a consequence of food insecurity.

AIMS OF THE STUDY: We estimate the directional causal effect of food insecurity on mental health status and mental health treatment using bounding methods to partially identify the causal effects from food insecurity to mental health status and mental health treatment.

METHODS: Data on food security, mental health status, mental health treatment, and individual and family socioeconomic characteristics for adults come from the nationally representative 2016 and 2017 Medical Expenditure Panel Survey. We use both the continuous score (0-10) of a 10-question module on food security as well as classifying adults as living in households that are food secure (0) or having marginal (1-2), low (3-5), or very low food security (6-10). Mental health status is measured using the Kessler-6 (K6) and the PHQ2 depression screening scales. A K6 score of 13 or greater indicates serious psychological distress while a score of 7 to 12 indicates moderate distress. A score of 3 or more on the PHQ-2 indicates probable depression. Mental health treatment is measured by ambulatory mental health visits, prescriptions for psychotropic medications, and total mental health expenditures. Standard parametric regression models are used as a baseline for partial identification models that bound the effects of food security on mental health. In our preferred specification, we impose the following assumptions: monotone treatment selection (MTS), monotone treatment response (MTR), and monotone instrumental variables (MIV) using household income as an instrument.

RESULTS: Those living in food insecure households are more likely to experience psychological distress and depression than those who in food secure households, but do not seek commensurately more mental health treatment. Non-parametric bounds suggest food insecurity increases the probability of moderate psychological distress by no more than 7.2 percentage points, serious psychological distress by no more than 3 percentage points, and probable depression by no more than 4.2 percentage points. The estimated effect sizes of food security on mental health treatment are much smaller, with treatment uptake increasing by no more than 2.4 percentage points.

DISCUSSION: Our parametric results are consistent with prior findings on the relationship between food security and mental health. We provide evidence for a causal effect of food insecurity which may account for about half the observed association of food security on mental health. A new and previously unreported result indicates that, despite poorer mental health, the food insecure do not show similar increases in mental health care. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE / IMPLICATIONS FOR HEALTH POLICIES: Our results provide policy relevant bounds on the causal impact of food insecurity on mental health. These results raise concerns about the mental health treatment gap in the food insecure population. The relative lack of treatment may point towards deeper structural issues in access to mental health treatment.

PMID:39931807

Addiction. 2025 Feb 11. doi: 10.1111/add.70001. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

DESIGN: Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

SETTING AND PARTICIPANTS: For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

MEASUREMENTS: Genetic variants associated with NMR (n = 6) and CPD (n = 53).

FINDINGS: Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

CONCLUSIONS: The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

PMID:39931798 | DOI:10.1111/add.70001

Spine (Phila Pa 1976). 2025 Feb 11. doi: 10.1097/BRS.0000000000005248. Online ahead of print.

ABSTRACT

STUDY DESIGN: Monocentric, retrospective, cross-sectional study.

OBJECTIVE: To investigate the age-related normative values of sagittal parameters and establish their relationships in asymptomatic community-dwelling adults aged over 50.

BACKGROUND CONTEXT: Degenerative changes in the spine with aging alter the sagittal balance, causing spine pathologies. However, there was a lack of comprehensive study on age-related normative values of sagittal alignment and their relationship during degenerative evolution.

METHODS: Among a total of 1,370 volunteers, 701 asymptomatic volunteers were recruited. Participants underwent a lateral X-ray, and sagittal parameters were assessed using a customized computer application.

RESULTS: Age showed a stronger correlation with upper arc of thoracic kyphosis (Upper_TK) (r=0.39) compared to sagittal vertical axis (SVA) (r=0.28) and T1_slope (r=0.29). Lumbar lordosis (LL) did not exhibit a significant decrease with age. The geometrical relationship revealed a significant correlation between TK and LL (r=0.52), and LL and pelvic incidence (PI) (r=0.63), as per the equations: TK=Upper_TK+Lower arc of TK (Lower_TK), LL=Upper arc of LL (Upper_arc)+sacral slope (SS), Lower_TK≈Upper_arc, and PI=SS+pelvic tilt (PT). However, after removing intermediate control variables of Lower_TK (Upper_arc) and SS, the correlation between TK, LL, and PI was statistically weak, due to the little to no correlation between Lower_TK (Upper_arc), SS, and PT. Upper_arc (Lower_TK) was a relatively stable parameter with an age-independent value of 15.93±5.61° in elderly adults. For adults aged 60, Upper_TK significantly increased with age, while individuals over 75 exhibited a significant increase in PT and a decrease in SS and LL.

CONCLUSIONS: Our study provided a normative age-related value of spinal sagittal parameters. To assess the spinal sagittal alignment, it was suggested that LL and TK be divided into two tangential arches based on the location of the lordotic or kyphotic apex. This study offered insights for spine surgeons in preparing for surgical corrections.

PMID:39931787 | DOI:10.1097/BRS.0000000000005248

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Sept 28;49(9):1477-1494. doi: 10.11817/j.issn.1672-7347.2024.230539.

ABSTRACT

OBJECTIVES: Persistent pulmonary hypertension of the newborn (PPHN) is a complex disease with poorly understood mechanisms and risk factors. Developing animal models that reflect the pathophysiological characteristics of PPHN is critical for studying its pathogenesis and treatment strategies. This study aims to analyze the applications, methodologies, and evaluation criteria of PPHN animal models through systematic literature analysis, and to provide guidelines for establishing scientific, cost-effective, and reproducible models.

METHODS: Relevant studies published until March 2023 were retrieved from Chinese databases (CNKI, Wanfang, VIP, and SinoMed) and English databases (PubMed, Web of Science, and Embase). Data were extracted on the applications, species, modeling methods and their principles, specific procedures, species and ages of animals used, and time to model establishment, and criteria for evaluating successful model establishment. A database was created and statistical analyses were performed using Excel 2021, with results presented as charts.

RESULTS: A total of 1 157 studies were identified, and 174 met the inclusion criteria. PPHN animal models were primarily used for pathophysiological and mechanistic research (47.70%). The species used including sheep, pigs, rats, cows, and mice, ranked by frequency of use. Modeling methods were categorized into 4 types: Hypoxia exposure (44.69%), prenatal ductus arteriosus (DA) constriction (41.34%), pharmacological induction (8.94%), and combined induction (hypoxia and indomethacin, 5.03%). Each method was associated with specific species and ages. Prenatal DA constriction was exclusively performed in fetal sheep. The time to model establishment varied: Hypoxia exposure typically required >3 days, prenatal DA constriction had a median of 8.5 days, and combined induction took 3 days. Criteria for evaluating successful model establishment were categorized into 5 dimensions: Anatomical structure, histological features, hemodynamic parameters, blood gas analysis, and other physiological indicators. The most common criteria were “right ventricular hypertrophy” and “significant pulmonary arterial pressure elevation”.

CONCLUSIONS: Current methods for modeling PPHN in animals are diverse, each with its strengths and limitations. Researchers should select the method most suitable for their study objectives and budget. Further exploration is needed to develop scientifically robust, cost-effective, and reproducible animal models for PPHN.

PMID:39931778 | DOI:10.11817/j.issn.1672-7347.2024.230539

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Sept 28;49(9):1431-1439. doi: 10.11817/j.issn.1672-7347.2024.230488.

ABSTRACT

OBJECTIVES: Polypoidal choroidal vasculopathy (PCV) is a major cause of vision loss among older adults worldwide and is particularly common in Asians. When the aneurysmal dilatation of blood vessels or the rupture of widened small veins/arteries occurs, it leads to submacular hemorrhage (SMH), which can result in irreversible damage to vision over time. This study aims to evaluate the surgical outcomes and complications of pars plana vitrectomy (PPV) combined with intraoperative subretinal injection of tissue-type plasminogen activator (t-PA) and postoperative intravitreal injection of anti-vascular endothelial growth factor (VEGF) for the treatment of SMH secondary to PCV.

METHODS: Thirteen patients (13 eyes) with SMH secondary to PCV treated at the Eye Center, Xiangya Hospital, Central South University, from September 2020 to December 2021, were included in this study. All patients underwent PPV combined with subretinal injection of t-PA during surgery and received postoperative intravitreal injections of anti-VEGF. Best corrected visual acuity (BCVA), intraocular pressure, absorption of subretinal hemorrhage, progression of the primary lesion, surgical complications, and factors associated with postoperative efficacy were analyzed preoperatively, 1 week postoperatively, 1 month postoperatively, and 6 months postoperatively.

RESULTS: All patients completed the 6-month follow-up, and at the final visit, 100% of the subretinal hemorrhage of 13 patients was completely cleared. BCVA significantly improved at both 1 month and 6 months postoperatively compared to preoperative and 1-week postoperative levels (all P<0.05). Patients over 60 years old and those with lesions located beneath the fovea had statistically significant differences in visual recovery compared to younger patients and those with extrafoveal lesions (P=0.045 and P=0.006, respectively). No significant correlation was found between disease duration, extent of hemorrhage, presence or absence of preoperative vitreous hemorrhage (VH), and visual recovery at 6 months postoperatively (all P>0.05). Ten patients had an intact ellipsoid zone, and 5 patients had an intact retinal pigment epithelium layer, however, the difference in preoperative and postoperative visual acuity between those with and without intact microstructures was not statistically significant (all P>0.05). At the final follow-up, 2 patients had retinal neuroepithelial edema, and 1 patient had retinal pigment epithelium layer detachment. Postoperative complications included 1 patient of macular hole and 1 patient of retinal pigment epithelium layer tear.

CONCLUSIONS: PPV combined with subretinal t-PA injection and postoperative intravitreal anti-VEGF injection effectively clears SMH secondary to PVC with few surgical complications and significantly improves visual function of the patients over 6-month long-term follow-up.

PMID:39931773 | DOI:10.11817/j.issn.1672-7347.2024.230488

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Sept 28;49(9):1421-1430. doi: 10.11817/j.issn.1672-7347.2024.230603.

ABSTRACT

OBJECTIVES: The early imaging features of spinal tumors and spinal infections are similar, and the lack of specific early diagnostic indicators can lead to misdiagnosis or missed diagnosis. Although serum tumor markers have been widely used in early cancer screening, spinal tumors are mostly metastatic, lacking specific markers, and some patients with spinal tumors may even test negative for tumor markers. Therefore, the role of tumor markers in the early differential diagnosis of spinal tumors remains unclear. This study aims to investigate the value of tumor markers in the early differential diagnosis of spinal tumors and spinal infection.

METHODS: We retrospectively analyzed the clinical data of 221 patients with spinal bone destruction admitted to Xiangya Hospital of Central South University between April 2017 and October 2022. Peripheral blood levels of 10 tumor markers were measured upon admission, including carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), neuron-specific enolase (NSE), cytokeratin 19 fragment antigen 21-1 (cyfra21-1), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), carbohydrate antigen 72-4 (CA72-4), pepsinogen I (PGI), pepsinogen II (PGII), and the PGI/PGII ratio (PGR). Univariate Logistic analysis was used to screen relevant variables, and the correlation between tumor markers was analyzed. Multivariate Logistic regression was then employed to identify risk and protective factors. The optimal cut-off values were calculated using the receiver operating characteristic (ROC) curve and Youden index, and a differential diagnosis model for early spinal tumors and spinal infections was constructed based on the selected indicators. Diagnostic performance was then evaluated.

RESULTS: According to the pathological diagnosis, 91 patients had spinal tumors, and 130 patients had spinal infections. The levels of CEA, AFP, NSE, cyfra21-1, CA199, and CA72-4 were higher in the spinal tumor group than those in the spinal infection group, while PGR was lower, with statistically significant differences (all P<0.05). Univariate Logistic analysis showed significant differences in CEA, AFP, NSE, cyfra21-1, CA199, CA125, CA72-4, and PGR (all P<0.05). Correlation analysis indicated a strong positive correlation between CEA and cyfra21-1, CA199, and CA125, as well as a strong negative correlation of PGII with PGI and PGR. Multivariate Logistic analysis identified AFP and cyfra21-1 as risk factors (P<0.01) and PGR as a protective factor (P<0.05). When the standard cut-off values (AFP<20 ng/mL, cyfra21-1< 3.3 ng/mL, and PGR>3) were applied, AFP had a sensitivity of 3.3% and accuracy of 60.2%, cyfra21-1 had a sensitivity of 20.9% and accuracy of 66.1%, and PGR had a sensitivity of 2.2% and accuracy of 59.3%. The AUC of the early spinal tumor diagnosis model was 0.623. Using the optimal cut-off values (AFP<1.625 ng/mL, cyfra21-1<1.175 ng/mL, and PGR>11.05) from the ROC curve, AFP had a sensitivity of 69.2% and accuracy of 64.7%, cyfra21-1 had a sensitivity of 68.1% and accuracy of 70.1%, and PGR had a sensitivity of 62.6% and accuracy of 57.5%, with the model’s AUC at 0.772.

CONCLUSIONS: A comparative analysis of 10 serum tumor markers reveals that AFP, cyfra21-1, and PGR are significantly associated with spinal tumors. The diagnostic model constructed based on these 3 markers shows promising predictive performance and may be helpful to the differentiation for the early clinical diagnosis of spinal tumors and spinal infection.

PMID:39931772 | DOI:10.11817/j.issn.1672-7347.2024.230603

Health Promot J Austr. 2025 Apr;36(2):e70020. doi: 10.1002/hpja.70020.

ABSTRACT

ISSUE ADDRESSED: Type 2 diabetes (T2D) prevalence in Thailand is rapidly increasing, with significant challenges in achieving optimal glycemic control. There is a need for accessible interventions to help improve glycaemic control in people with type 2 diabetes in Thailand. This study evaluates a web application designed to enhance self-management in individuals with uncontrolled T2D. Pre- and post-intervention results indicate a statistically significant reduction in fasting blood glucose. Despite the inability to effectively utilise the web application for controlling blood sugar levels, the study suggests its suitability and potential for benefiting diabetes patient care.

BACKGROUND: Diabetes is a rapidly growing global health concern, with an estimated 537 million people affected worldwide in 2021, a number projected to rise to 783 million by 2045. In Thailand, diabetes cases have increased significantly, with over 3.3 million individuals affected in 2022. Effective diabetes management requires strict adherence to self-care behaviors, including diet, exercise, medication adherence, and glucose monitoring. However, many patients struggle with self-management, leading to severe complications. The integration of a web application in diabetes care has shown potential for enhancing patient engagement and glycemic control. This study explores the role of a web application in improving diabetes self-management and health outcomes.

METHOD: The quasi-experimental single-group research, assessing pre- and post-intervention outcomes, aims to investigate the feasibility of using a web application for diabetes patient care in controlling blood sugar levels. The study employs a web application focusing on dietary behaviour adjustment, physical activity and exercise among 80 diabetes patients selected through simple randomisation. Additionally, 10 nurses responsible for healthcare promotion at five hospitals oversee and empower patients’ behaviours over two months. The research concentrates on exploring the feasibility of the web application and includes (I) the application’s suitability and (II) the patient’s blood sugar levels. The research collected quantitative and qualitative data from November 2022 to May 2023. Tools used for data collection include the feasibility assessment and application suitability.

RESULTS: The research findings indicate that the primary assessment regarding the feasibility of using the web application for diabetes patient care in controlling blood sugar levels shows overall high feasibility. The overall assessment also falls within a high range. Comparing the average levels of fasting blood sugar (FBS) before and after using the web application showed a statistically significant decrease (p-value = 0.023). When comparing the average FBS levels before and after using the web application among diabetes patients, the average FBS decreased significantly from 157.07 ± 47.248 mg/dL to 150.00 ± 43.325 mg/dL (p = 0.023). However, the HbA1c levels showed no statistically significant change (9.17% ± 1.76 to 9.12% ± 1.82, p = 0.38). SO WHAT?: These outcomes may positively contribute to early effective interventions and as well as appropriate responses to diabetes mellitus. Further supported for the health care professionals the use of a web application for diabetes patient care in patients with poorly controlled blood sugar. Specifically, for patients with smartphones, this intervention could help address their issues and provide tools for better self-regulation of their eating habits, physical activities and overall well-being. This can lead to better blood sugar control efficacy.

PMID:39931764 | DOI:10.1002/hpja.70020

J Ultrasound Med. 2025 Feb 11. doi: 10.1002/jum.16660. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to compare changes in ultrasonic Doppler parameters, particularly the peak ratio (PR) of the ophthalmic artery (OA) and optic nerve sheath diameter (ONSD), in pregnancies complicated by fetal growth restriction (FGR). Furthermore, it sought to evaluate differences in these parameters across various subgroups and analyze the cut-off value of PR for predicting delivery within 1 week in pregnancies complicated by FGR.

METHODS: A total of 62 pregnant women in the mid-to-late stages of gestation were enrolled, comprising 31 participants in the FGR group and 31 in the control group. The general conditions, pregnancy outcomes, Doppler parameters of the OA, and ONSD were compared between the two groups. Comparative analysis was performed to investigate differences in OA Doppler parameters and ONSD across FGR subgroups. The predictive value of PR for delivery within 1 week was assessed using the area under the receiver operating characteristic curve.

RESULTS: The PR of the OA was significantly elevated in the FGR group compared to the control group, demonstrating a statistically significant difference. The threshold PR value for predicting delivery within 1 week was 0.565, with a sensitivity of 0.88 and a specificity of 0.58.

CONCLUSIONS: The PR value of the OA in pregnant women with FGR is significantly increased and may serve as a reliable predictor for pregnancies complicated by FGR.

PMID:39931757 | DOI:10.1002/jum.16660

Front Sports Act Living. 2025 Jan 27;7:1500723. doi: 10.3389/fspor.2025.1500723. eCollection 2025.

ABSTRACT

The study examined the effect of a 5-week Comprehensive School Physical Activity Program (CSPAP) on overhand throw skills and perceived motor competence in students from low socio-economic backgrounds. Participants were children recruited from a Title 1 school in the Southwest U.S. Students were assigned to either CSPAP condition (n = 60, 26 boys, 34 girls; Mgrade = 4.27, SD = .43) or a control condition (n = 20, 7 boys, 13 girls; Mgrade = 4.00, SD = .35). Overhand throwing and perceived motor competence were assessed at baseline and post-intervention using the Test of Gross Motor Development-2nd Edition and Perceived Motor Competence for Children (PMC-C). The Analysis of Covariance test showed that students who participated in the CSPAP performed statistically significant improvements in the overhand throw compared to control students in the post-test p < .001, with a moderate effect size. However, there was no significant difference in the PMC-C score after the 5-week intervention between the CSPAP students and control students. CSPAP can improve overhand throwing in students from low-income families, but new strategies are needed to enhance perceived motor competence in after-school contexts.

PMID:39931734 | PMC:PMC11808130 | DOI:10.3389/fspor.2025.1500723