Nevin Manimala

N Z Med J. 2025 Feb 28;138(1610):39-51. doi: 10.26635/6965.6404.

ABSTRACT

AIM: To estimate the current prevalence of dysphagia in the Aotearoa New Zealand population and to project its prevalence to 2073.

METHODS: The current prevalence of dysphagia in Aotearoa New Zealand is computed from the prevalences of the aetiologies of dysphagia combined with the rates at which the aetiologies result in dysphagia. Projected dysphagia rates use autoregressive integrated moving average forecasting techniques combined with population projections from Statistics New Zealand and estimates of current and past prevalence rates of dysphagia.

RESULTS: The prevalence of dysphagia in Aotearoa New Zealand is estimated to have been approximately 1.78% in 2020, with the biggest aetiological contributors being stroke, Alzheimer’s disease and other dementias, and gastroesophageal reflux disease. These three causes made up 81.5% of all estimated dysphagia cases in 2019. The prevalence rate of dysphagia in Aotearoa New Zealand is projected to rise to 2.54%, reflecting the ageing population.

CONCLUSION: An increased prevalence of dysphagia will result in an increased healthcare burden, both from resources spent on treating dysphagia and complications stemming from undiagnosed and thus untreated dysphagia. Estimating the full extent of this increased burden is hampered by the absence of systematic, extensive and reliable records available relating to cases of dysphagia in Aotearoa New Zealand.

PMID:40014770 | DOI:10.26635/6965.6404

N Z Med J. 2025 Feb 28;138(1610):13-30. doi: 10.26635/6965.6801.

ABSTRACT

AIM: To characterise patient mortality risk following intensive care unit (ICU) admitted community-acquired sepsis (CAS) in Aotearoa New Zealand (Aotearoa), comparing in-hospital and post-discharge mortality and associated risk factors.

METHODS: We examined de-identified, linked ICU-admitted adult patient data from ICU sites in Aotearoa retrieved from the Australian and New Zealand Intensive Care Society’s CORE adult patient database (ANZICS-CORE-APD) between 2009 and 2019. Patients were followed from ICU admission to death or 365 days post-hospital discharge alive, using descriptive, survival and regression analyses. The outcomes of interest were in-hospital mortality and post-discharge mortality during the first 365 days.

RESULTS: In-hospital mortality was 16.3%. Post-discharge mortality was 3.6% by 30 days after discharge, 9.1% by 180 days and 12.9% by 365 days. There was no significant difference in in-hospital mortality risk by ethnicity or New Zealand Index of Deprivation quintile of usual residence. By contrast, significant differences in post-discharge survival were observed by ethnicity, area deprivation quintile and presence of severe comorbidities, particularly for Māori usually resident in high-deprivation areas.

CONCLUSIONS: There was no evidence of associations between in-hospital mortality and ethnicity or socio-economic deprivation; however, these associations become marked post-discharge. Interventions should be implemented to support early identification and management of CAS and address health inequities following hospital discharge.

PMID:40014768 | DOI:10.26635/6965.6801

J Prim Care Community Health. 2025 Jan-Dec;16:21501319251320181. doi: 10.1177/21501319251320181.

ABSTRACT

BACKGROUND: Readmission can be be related to the work of several stakeholders involved in the care of individuals throughout the community, including, for example, primary care and social care providers. A narrative review was performed to assess definitions and frequency of readmission for older adults found in previous research. In addition, a dataset for a cohort of older adults in Stockholm, Sweden, was used to quantify how different definitions of readmission affect frequency.

MATERIALS AND METHODS: The review was based on pre-specified search criteria within PubMed and Embase databases. All studies based on a cohort of older adults with a primary objective to assess readmission to inpatient care, were included for the assessment of readmission criteria. The dataset was based on a cohort of older adults treated at a geriatric department in Stockholm during 2016. Estimations of readmission were performed with the most common criteria found in the narrative review.

RESULTS: The narrative review showed that definitions of readmission included predominantly time-based criteria, either alone or combined with additional criteria such as medical condition or readmitting department. Frequency of readmission based on different definitions varied substantially; a 14-day time interval implied a rate of 8.0% whilst a 30-day interval-more commonly used-rendered a rate of 12.6%. The density of readmissions per day was higher during the first weeks after discharge, and then dropped continuously.

CONCLUSION: Transparency on definitions is imperative in studies that include rates of readmission. The levels of readmission rates are highly dependent on the study population and its context. Furthermore, the actual value of readmission monitoring is dependent on what purpose it is supposed to fulfill, and it is essential to put it into context of all relevant stakeholders including, for example, the primary care providers and different social care providers throughout the community.

PMID:40014763 | DOI:10.1177/21501319251320181

Scand J Pain. 2025 Feb 27;25(1). doi: 10.1515/sjpain-2024-0018. eCollection 2025 Jan 1.

ABSTRACT

OBJECTIVES: Chronic pain causes loss of workability, and pharmacological treatment is often not sufficient, whereas psychosocial treatments may relieve continual pain. This study aimed to investigate the effect of peer group management intervention among patients with chronic pain.

METHODS: The participants were 18-65-year-old employees of the Municipality of Helsinki (women 83%) who visited an occupational health care physician, nurse, psychologist, or physiotherapist for chronic pain lasting at least 3 months. An additional inclusion criterion was an elevated risk of work disability. Our study was a stepped wedge cluster, randomized controlled trial, and group interventions used mindfulness, relaxation, cognitive behavioral therapy, and acceptance and commitment therapy. We randomized sixty participants to either a pain management group intervention or to a waiting list with the same intervention 5 months later. After dropouts, 48 employees participated in 6 weekly group meetings. We followed up participants from groups A, B, and C for 12 months and groups D, E, and F for 6 months. As outcome measures, we used the pain Self-Efficacy Questionnaire, the number of areas of pain, the visual analog scale of pain, and the pain self-efficacy. We adjusted the results before and after the intervention for panel data, clustering effect, and time interval.

RESULTS: The peer group intervention decreased the number of areas of pain by 40%, from 5.96 (1-10) to 3.58 (p < 0.001), and increased the pain self-efficacy by 15%, from 30.4 to 37.5 (p < 0.001). Pain intensity decreased slightly, but not statistically significantly, from 7.1 to 6.8.

CONCLUSIONS: Peer group intervention for 6 weeks among municipal employees with chronic pain is partially effective. The number of areas of pain and pain self-efficacy were more sensitive indicators of change than the pain intensity. Any primary care unit with sufficient resources may implement the intervention.

PMID:40014757 | DOI:10.1515/sjpain-2024-0018

Womens Health (Lond). 2025 Jan-Dec;21:17455057251322815. doi: 10.1177/17455057251322815.

ABSTRACT

BACKGROUND: Women in couples experiencing infertility are at heightened risk for intimate partner violence (IPV) from husbands and domestic violence (DV) from family. Couples experiencing infertility in Jordan, a patriarchal culture with high rates of IPV and DV, are particularly vulnerable. This article explores the gendered similarities and differences in the experiences of mental health, social support, exclusion, and IPV.

OBJECTIVES: The objectives of this study are to understand both men and women’s perspectives on their experiences of infertility and to develop intervention strategies to reduce IPV among married couples experiencing infertility.

DESIGN: This study is a descriptive, observational study.

METHODS: Through quantitative surveys and in-depth qualitative interviews, we examined key themes including: challenges to mental health and well-being; reproductive health and fertility care-seeking; experiences of shame, isolation, and discrimination; coping skills; sources of support; and challenges within spousal and family relationships.

RESULTS: In this article, we analyze primary areas of gender discordance and discuss how gendered experiences can shape implementation of psychosocial support intervention programs to prevent IPV. Our findings provide important insight into facilitators and barriers to prevention of IPV in this vulnerable group.

CONCLUSION: We conclude that providing both women and men with culturally appropriate support during fertility treatment-seeking can improve psychosocial health and couple functioning and ultimately to reduce the occurrence of IPV in this vulnerable population.

PMID:40014755 | DOI:10.1177/17455057251322815

Telemed J E Health. 2025 Feb 27. doi: 10.1089/tmj.2025.0011. Online ahead of print.

ABSTRACT

Objective: The Health Resources and Services Administration (HRSA)-funded health centers provide critical behavioral health services to historically and medically underserved individuals with complex health and social needs. As health centers rapidly expanded telehealth in response to COVID-19, the objective of the study was to assess whether telehealth use was associated with utilization and continuity within mental health care received by patients of HRSA-funded health centers. Methods: Cross-sectional analyses, using a nationally representative sample of adult patients with mental health needs from the 2022 Health Center Patient Survey (n = 1,044), explored associations between telehealth use and utilization of mental health services from primary care providers (PCP) and continuity of counseling services. Multivariate logistic regression models accounted for predisposing, enabling, and need factors to assess the influence of telehealth use on utilization and continuity outcomes. Results: After adjusting for patient-level factors, telehealth users with mental health needs had statistically significant and higher odds of receiving mental health services from a PCP at a health center compared with nontelehealth users (adjusted odds ratios [aOR] = 2.60, p < 0.001; 95% confidence interval [CI] [1.50, 4.52]). Telehealth-using patients receiving counseling services had statistically significant and higher odds of receiving all counseling services at a health center compared with nontelehealth users (aOR = 3.65, p < 0.001, 95% CI [2.04, 6.53]). Conclusions: Telehealth facilitates mental health care utilization and continuity for historically and medically underserved patients at health centers and can be an important tool for care management and coordination for patients with mental health needs, particularly during and following public health emergencies.

PMID:40014364 | DOI:10.1089/tmj.2025.0011

Invest Ophthalmol Vis Sci. 2025 Feb 3;66(2):68. doi: 10.1167/iovs.66.2.68.

ABSTRACT

PURPOSE: This study aims to evaluate the metabolism of serum-modified nucleosides in uveitis by using liquid chromatography-tandem mass spectrometry (LC-MS) and to develop potential diagnostic biomarkers for uveitis.

METHODS: Forty-two patients with different subtypes of uveitis (idiopathic uveitis, Vogt-Koyanagi-Harada [VKH] disease, and ankylosing spondylitis [AS]) and 32 healthy controls were recruited in this retrospective case-control study. The concentrations of 23 modified nucleosides in patient serum were quantified by LC-MS. The data was statistically analyzed with SPSS and GraphPad Prism.

RESULTS: The data revealed that 13 out of 23 modified nucleosides (m6A, m1A, m6Am, Cm, ac4C, Gm, m1G, m2G, m2,2G, Um, m3U, m5U, and m5Um) effectively showed quantifiable chromatographic peaks. The statistical results indicated that there were extremely significant differences for m2G, Gm, Cm, and m1G between healthy controls and uveitis patients. The differences for Gm, m6A,and m5U were able to further assort idiopathic uveitis and uveitis with systemic inflammation including VKH and AS. Interestingly, each specific subtype of uveitis is characterized by its signature combination of serum-modified nucleotides comparing with healthy controls.

CONCLUSIONS: This study revealed that the metabolism of serum-modified nucleosides in uveitis patients display significant differences from healthy controls. The signature combination of serum modified nucleotides for each subtype of uveitis may be applied for the potential diagnosis of uveitis.

PMID:40014362 | DOI:10.1167/iovs.66.2.68

JAMA Netw Open. 2025 Feb 3;8(2):e2462069. doi: 10.1001/jamanetworkopen.2024.62069.

ABSTRACT

IMPORTANCE: Homicide is one of the leading causes of death in the US, especially among adolescents and adults younger than 45 years. While geographic, racial and ethnic, and sex differences in homicide rates have been documented, a comprehensive assessment across all sociodemographics is needed.

OBJECTIVE: To assess variation in US homicide rates from 2000 to 2019 across geographic location, race and ethnicity, sex, and age.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used deidentified death records from the National Vital Statistics System and population estimates from the National Center for Health Statistics for all individuals living in the US from January 1, 2000, to December 31, 2019. Data analysis was completed in April 2023.

EXPOSURE: County, race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White), age (0-14, 15-24, 25-44, 45-64, and ≥65 years), and sex (female and male) as reported on death certificates.

MAIN OUTCOMES AND MEASURES: The main outcome was homicide rates per 100 000 individuals. Validated small-area estimation models were used to estimate county-level homicide rates by race and ethnicity, age, and sex (50 unique populations). Estimates were corrected for race and ethnicity misclassification on death certificates and were age standardized.

RESULTS: Between 2000 and 2019, there were 367 827 (95% uncertainty interval [UI], 366 683-369 046) homicides in the US, with decedents most commonly being male (77.7% [95% UI, 77.5%-77.8%]), aged 15 to 44 years (69.8% [95% UI, 69.6%-69.9%]), and Black (46.0% [95% UI, 45.5%-46.5%]). The highest homicide rates were among Black males aged 15 to 24 years (74.6 [95% UI, 72.3-77.0] per 100 000 population) and 25 to 44 years (70.0 [95% UI, 68.4-71.4] per 100 000 population) followed by American Indian and Alaska Native males aged 15 to 24 years (24.5 [95% UI, 19.2-31.0] per 100 000 population) and 25 to 44 years (33.5 [95% UI, 28.6-38.8] per 100 000 population). Homicide rates higher than 100 deaths per 100 000 population among American Indian or Alaska Native or Black males aged 15 to 44 years were observed in 143 counties; more than 25% of counties with this homicide level among Black males were in Arkansas, Louisiana, and Mississippi, and all counties with this homicide level among American Indian or Alaska Native males were in North Carolina. Despite national homicide rates remaining stable over the study period (6.1 [95% UI, 6.0-6.2] per 100 000 population for both years; incidence rate difference, 0.04 [95% UI, -0.16 to 0.07]), homicide rates increased in most counties (range, 1631 of 3051 [53.5%] to 1406 of 1488 [94.5%]) among American Indian or Alaska Native, Black, and White males and females younger than 65 years.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US homicide rates, substantial variation was found across and within county, race and ethnicity, sex, and age groups; American Indian and Alaska Native and Black males aged 15 to 44 years had the highest rates of homicide. The findings highlight several populations and places where homicide rates were high, but awareness and violence prevention remains limited.

PMID:40014342 | DOI:10.1001/jamanetworkopen.2024.62069

JAMA Netw Open. 2025 Feb 3;8(2):e2462117. doi: 10.1001/jamanetworkopen.2024.62117.

ABSTRACT

IMPORTANCE: Short and long sleep durations are adversely associated with cardiovascular disease (CVD), type 2 diabetes, and mortality. It remains unclear how sleep duration trajectories over time are associated with mortality and whether these associations vary by well-documented sex, race, and socioeconomic sleep disparities.

OBJECTIVE: To investigate the association of 5-year sleep duration trajectories with all-cause and cause-specific mortality among US adults, predominantly those in low-income groups.

DESIGN, SETTING, AND PARTICIPANTS: The Southern Community Cohort Study included participants aged 40 to 79 years recruited and enrolled (from March 2002 to September 2009) from community health centers by using random sampling methods across 12 states in the Southeastern US. Participants completed a follow-up survey between 2008 and 2013. Data analysis was performed from August 10 to November 30, 2023.

EXPOSURES: Sleep duration was self-reported at study enrollment and at 5-year follow-up. At each time point, sleep was categorized as short (<7 hours), healthy (7-9 hours), or long (>9 hours). Nine sleep trajectories were defined based on 5-year change or consistency in sleep duration category between enrollment and follow-up.

MAIN OUTCOME AND MEASURES: Cause of death was ascertained via linkage to the National Death Index through December 31, 2022. Multivariable-adjusted Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs) and 95% CIs for mortality outcomes (all-cause, CVD, cancer, and neurodegenerative disease) associated with sleep duration trajectory.

RESULTS: Participants included 46 928 adults (mean [SD] age, 53.0 [8.8] years; 65.4% women; 63.3% self-identified as Black and 36.7% as White; and 47.5% with a household income <$15 000 per year). Overall, 66.4% of participants had suboptimal 5-year sleep trajectories. Race varied across sleep trajectories; 53.0% of participants in the optimal trajectory were Black, compared with 84.5% in the long-short trajectory. During a median 12.6 (IQR, 11.3-13.1) years of follow-up, 13 579 deaths occurred (4135 from CVD, 3067 from cancer, and 544 from neurodegenerative diseases). Compared with the optimal sleep duration trajectory, suboptimal trajectories were associated with as much as 29% greater risk of all-cause mortality in fully-adjusted models. For all-cause and CVD-specific mortality, the long-long (HRs, 1.27 [95% CI, 1.14-1.41] and 1.22 [95% CI, 1.01-1.48], respectively) short-long (HRs, 1.29 [95% CI, 1.17-1.42] and 1.22 [95% CI, 1.03-1.45], respectively), and long-short (HRs, 1.19 [95% CI, 1.05-1.35] and 1.32 [95% CI, 1.07-1.63], respectively) trajectories were associated with the greatest risk. After adjustment for comorbid conditions, no associations were observed for mortality due to cancer or neurodegenerative disease. Observed associations varied by race and household income, with the greatest risk observed among White adults with greater household incomes.

CONCLUSIONS AND RELEVANCE: In this cohort study of 46 928 US residents, nearly two-thirds of participants had suboptimal 5-year sleep duration trajectories. Suboptimal sleep duration trajectories were associated with as much as a 29% increase in risk of all-cause mortality. These findings highlight the importance of maintaining healthy sleep duration over time to reduce mortality risk.

PMID:40014341 | DOI:10.1001/jamanetworkopen.2024.62117

Chaos. 2025 Feb 1;35(2):023167. doi: 10.1063/5.0241503.

ABSTRACT

The Atlantic Meridional Overturning Circulation (AMOC) stability landscape is commonly investigated with single-realization hysteresis diagrams driven by freshwater input in the North Atlantic Ocean. However, the effect of CO2 forcing on one side and the role of internal climate variability on the timing of tipping and the AMOC hysteresis on the other side remain less explored. Here, we address this gap by running three independent AMOC hysteresis simulations, consisting of a slow ramp-up plus ramp-down in the CO2 concentration (0.2 ppm/year) within the PlaSim-Large-Scale Geostrophic (LSG) intermediate complexity model. We show that the realizations of the CO2-driven hysteresis cycle, and particularly, the timing of the tipping and recovery, are remarkably affected by internal climate variability. In one of the three simulations, we even observe a reversed cycle, where the AMOC recovers at a higher CO2 level than at the collapse point. While statistical Early Warning Signals (EWSs) show some success in detecting the tipping points, we also find that the internal variability in the EWS considerably reduces the predictability of collapse and leads to false positives of an approaching AMOC tipping. We suggest that the AMOC collapse in the presence of internal climate variability may have characteristics that deviate substantially from the behavior seen in simple models and that caution is needed when interpreting results from a single-experiment realization. Our findings highlight the need for a probabilistic approach in defining a “safe operating space” for AMOC stability, since it might not be possible to define a single critical CO2 threshold to prevent AMOC collapse.

PMID:40014327 | DOI:10.1063/5.0241503