Nevin Manimala

Epidemiology. 2025 Jan 28. doi: 10.1097/EDE.0000000000001840. Online ahead of print.

ABSTRACT

BACKGROUND: Hospital regionalization involves balancing hospital volume and travel time. We investigated how hospital volume and travel time affect perinatal mortality and the risk of delivery in transit using three different study designs.

METHODS: This nationwide cohort study used data from the Medical Birth Registry of Norway (1999-2016) and Statistics Norway. We compared estimates across three designs: (1) Observed confounder adjustment: Comparing women giving birth at hospitals of different sizes and travel times (1,066,332 births), (2) Sibling comparison: Comparing women who moved between hospital catchment areas between births (203,464 births), (3) Neighbor comparison: comparing women living in neighboring municipalities, but in different hospital catchment areas (460,776 births).

RESULTS: The study population included 5080 (0.48%) perinatal deaths and 7063 deliveries in transit (0.66%). For hospitals with 2000 compared with 500 births/year, observed confounder adjustment showed 1.81 times higher perinatal mortality (95% confidence interval [CI] 1.21-2.73). However, sibling and neighbor comparisons showed a factor 0.64 (95% CI 0.43-0.97) and 0.61% (95% CI 0.43-0.88) lower perinatal mortality, respectively. Increased travel time was strongly associated with higher perinatal mortality using observed confounder adjustment, but this was not supported by the other designs. Longer travel time was consistently linked to an increased risk of delivery in transit.

CONCLUSIONS: Perinatal mortality was higher in high-volume hospitals when adjusting for observed confounders. However, triangulating inferences from the other designs suggested the opposite, estimating that observed confounder control was insufficient. This supports the idea that access to higher-volume hospitals could improve perinatal outcomes at the population level.

PMID:39874482 | DOI:10.1097/EDE.0000000000001840

Res Nurs Health. 2025 Jan 28. doi: 10.1002/nur.22447. Online ahead of print.

ABSTRACT

The patient activation measure (PAM), a recognized measure of how active patients are in their care, is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation. This study aimed to assess the psychometric properties and construct validity of the Italian version of the 13-item Patient Activation Measure (PAM13-I) among patients undergoing elective laparoscopic cholecystectomy. A multicenter study was conducted across 111 surgical units in Italy. This study involved the preoperative administration of the PAM questionnaire to 4532 patients. The psychometric properties of the PAM were evaluated using Rasch analysis. The PAM13-I demonstrated good internal consistency (Cronbach’s α = 0.95) and reliability indices. While fit statistics were acceptable, ceiling effects were observed. No significant differential item functioning was found. However, issues with targeting and local response dependency were identified. The Italian PAM-13 showed promising psychometric properties among surgical patients, indicating its potential utility in assessing patient activation. However, concerns regarding ceiling effects and targeting suggest the need for further refinement and validation in surgical populations.

PMID:39874068 | DOI:10.1002/nur.22447

J Magn Reson Imaging. 2025 Jan 28. doi: 10.1002/jmri.29719. Online ahead of print.

ABSTRACT

BACKGROUND: Multifrequency MR elastography (mMRE) enables noninvasive quantification of renal stiffness in patients with chronic kidney disease (CKD). Manual segmentation of the kidneys on mMRE is time-consuming and prone to increased interobserver variability.

PURPOSE: To evaluate the performance of mMRE combined with automatic segmentation in assessing CKD severity.

STUDY TYPE: Prospective.

PARTICIPANTS: A total of 179 participants consisting of 95 healthy volunteers and 84 participants with CKD.

FIELD STRENGTH/SEQUENCE: 3 T, single shot spin echo planar imaging sequence.

ASSESSMENT: Participants were randomly assigned into training (n = 58), validation (n = 15), and test (n = 106) sets. Test set included 47 healthy volunteers and 58 CKD participants with different stages (21 stage 1-2, 22 stage 3, and 16 stage 4-5) based on estimated glomerular filtration rate (eGFR). Shear wave speed (SWS) values from mMRE was measured using automatic segmentation constructed through the nnU-Net deep-learning network. Standard manual segmentation was created by a radiologist. In the test set, the automatically segmented renal SWS were compared between healthy volunteers and CKD subgroups, with age as a covariate. The association between SWS and eGFR was investigated in participants with CKD.

STATISTICAL TESTS: Dice similarity coefficient (DSC), analysis of covariance, Pearson and Spearman correlation analyses. P < 0.05 was considered statistically significant.

RESULTS: Mean DSCs between standard manual and automatic segmentation were 0.943, 0.901, and 0.970 for the renal cortex, medulla, and parenchyma, respectively. The automatically quantified cortical, medullary, and parenchymal SWS were significantly correlated with eGFR (r = 0.620, 0.605, and 0.640, respectively). Participants with CKD stage 1-2 exhibited significantly lower cortical SWS values compared to healthy volunteers (2.44 ± 0.16 m/second vs. 2.56 ± 0.17 m/second), after adjusting age.

CONCLUSION: mMRE combined with automatic segmentation revealed abnormal renal stiffness in patients with CKD, even with mild renal impairment.

PLAIN LANGUAGE SUMMARY: The renal stiffness of patients with chronic kidney disease varies according to the function and structure of the kidney. This study integrates multifrequency magnetic resonance elastography with automated segmentation technique to assess renal stiffness in patients with chronic kidney disease. The findings indicate that this method is capable of distinguishing between patients with chronic kidney disease, including those with mild renal impairment, while simultaneously reducing the subjectivity and time required for radiologists to analyze images. This research enhances the efficiency of image processing for radiologists and assists nephrologists in detecting early-stage damage in patients with chronic kidney disease.

LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 2.

PMID:39874058 | DOI:10.1002/jmri.29719

Lymphology. 2024;57(3):157-168.

ABSTRACT

This study examined the effect of lymphedema self-care patient school education on patient functionality, quality of life, body value, and lymphedema volume in patients with lower extremity lymphedema. The study utilized a single-group quasi-experimental design. The study sample included 21 patients with primary and secondary lower extremity lymphedema. A multidisciplinary team created a face-to-face lymphedema self-care patient education program that lasted three weeks with four hours each week to enhance lymphedema self-care management. Data collected from participants prior to the program and then at third and sixth months via Lower Extremity Functional Scale (LEFS), Lymphedema Functionality, Disability and Quality of Life Scale in Lower Extremity Lymphedema (LYMPH-ICF-LL), Body Value Scale, and extremity volumes. The average age of the patients was 54.85±11.99 years and two-thirds had secondary lymphedema. A statistically significant difference was found in the mean scores of LEFS (p<0.001), LYMPH-ICF-LL total (p= 0.006) in the 3rd and 6th months after the completion of the program, and in the lymphedema volume change (p= 0.031) in the 6th month. It was found that the lymphedema self-care patient school improved functionality and quality of life in patients with lower extremity lymphedema and decreased lymphedema volume. This lymphedema self-care patient education pro-gram is a safe and effective educational method for self-care management in individuals with lower extremity lymphedema.

PMID:39874052

JAMA Netw Open. 2025 Jan 2;8(1):e2456898. doi: 10.1001/jamanetworkopen.2024.56898.

ABSTRACT

IMPORTANCE: Climate change can adversely affect mental health, but the association of ambient temperature with psychiatric symptoms remains poorly understood.

OBJECTIVE: To assess the association of ambient temperature exposure with internalizing, externalizing, and attention problems in adolescents from 2 population-based birth cohorts in Europe.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from the Dutch Generation R Study and the Spanish INMA (Infancia y Medio Ambiente) Project. Generation R recruited 9898 women during pregnancy or shortly after birth, with children born between 2002 and 2006. INMA recruited 2270 pregnant women from Gipuzkoa, Sabadell, and Valencia, Spain, with children born between 2003 and 2008. Individuals born from live singleton births with available outcome and exposure data were included in the study. Data were analyzed between October 2023 and November 2024.

EXPOSURE: Daily ambient temperature 2 weeks, 1 month, and 2 months preceding outcome assessment was calculated between December 2015 and November 2022 at the residence at 100 × 100 m resolution utilizing the UrbClim model.

MAIN OUTCOMES AND MEASURES: The primary outcomes were internalizing, externalizing, and attention problems, measured with the maternal-reported Child Behavioral Checklist for ages 6 to 18 years; raw scores were square-root transformed, with higher scores indicating more problems. Distributed lag nonlinear models evaluated the associations of temperature exposure with problem scores in each country and region. For Spain, results from the 3 INMA regions were combined using random-effects meta-analysis. Results show the accumulated temperature association over each exposure period.

RESULTS: A total of 3934 participants from Generation R (mean [SD] age at assessment, 13.6 [0.4] years; 1971 female [50%]) and 885 from INMA (mean [SD] age at assessment, 14.9 [1.0] years; 458 female [52%]) were included. Most parents in both cohorts were native to the respective countries of each cohort and had relatively high socioeconomic status. Daily temperatures ranged from -5.2 °C to 32.6 °C in the Netherlands and 3.3 °C to 33.9 °C in Spain. In Generation R, the mean (SD) square-root transformed scores were 2.0 (1.2) for internalizing problems, 1.6 (1.3) for externalizing problems, and 1.5 (1.0) for attention problems, while in INMA these were 2.4 (1.2), 2.1 (1.3), and 1.5 (1.1), respectively. In the Netherlands, cumulative exposure to cold was associated with more internalizing problems (eg, 0.76 [95% CI, 0.20-1.32] higher square-root points at 5.5 °C exposure over a 2-month exposure). In Spain, cumulative exposure to heat was associated with more attention problems (eg, 1.52 [95% CI, 0.39-2.66] higher square-root points at 21.7 °C exposure over a 2-month exposure).

CONCLUSIONS AND RELEVANCE: In this cohort study, exposure to cold in the Netherlands and heat in Spain were associated with more psychiatric symptoms, highlighting distinct temperature exposure and mental health associations among adolescents. Future studies should explore this across diverse climates to further quantify the intricate and multifactorial association of climate change with mental health.

PMID:39874035 | DOI:10.1001/jamanetworkopen.2024.56898

JAMA Netw Open. 2025 Jan 2;8(1):e2457069. doi: 10.1001/jamanetworkopen.2024.57069.

ABSTRACT

IMPORTANCE: Cannabis use has increased globally, but its effects on brain function are not fully known, highlighting the need to better determine recent and long-term brain activation outcomes of cannabis use.

OBJECTIVE: To examine the association of lifetime history of heavy cannabis use and recent cannabis use with brain activation across a range of brain functions in a large sample of young adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data (2017 release) from the Human Connectome Project (collected between August 2012 and 2015). Young adults (aged 22-36 years) with magnetic resonance imaging (MRI), urine toxicology, and cannabis use data were included in the analysis. Data were analyzed from January 31 to July 30, 2024.

EXPOSURES: History of heavy cannabis use was assessed using the Semi-Structured Assessment for the Genetics of Alcoholism, with variables for lifetime history and diagnosis of cannabis dependence. Individuals were grouped as heavy lifetime cannabis users if they had greater than 1000 uses, as moderate users if they had 10 to 999 uses, and as nonusers if they had fewer than 10 uses. Participants provided urine samples on the day of scanning to assess recent use. Diagnosis of cannabis dependence (per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) was also included.

MAIN OUTCOMES AND MEASURES: Brain activation was assessed during each of the 7 tasks administered during the functional MRI session (working memory, reward, emotion, language, motor, relational assessment, and theory of mind). Mean activation from regions associated with the primary contrast for each task was used. The primary analysis was a linear mixed-effects regression model (one model per task) examining the association of lifetime cannabis and recent cannabis use on the mean brain activation value.

RESULTS: The sample comprised 1003 adults (mean [SD] age, 28.7 [3.7] years; 470 men [46.9%] and 533 women [53.1%]). A total of 63 participants were Asian (6.3%), 137 were Black (13.7%), and 762 were White (76.0%). For lifetime history criteria, 88 participants (8.8%) were classified as heavy cannabis users, 179 (17.8%) as moderate users, and 736 (73.4%) as nonusers. Heavy lifetime use (Cohen d = -0.28 [95% CI, -0.50 to -0.06]; false discovery rate corrected P = .02) was associated with lower activation on the working memory task. Regions associated with a history of heavy use included the anterior insula, medial prefrontal cortex, and dorsolateral prefrontal cortex. Recent cannabis use was associated with poorer performance and lower brain activation in the working memory and motor tasks, but the associations between recent use and brain activation did not survive false discovery rate correction. No other tasks were associated with lifetime history of heavy use, recent use, or dependence diagnosis.

CONCLUSIONS AND RELEVANCE: In this study of young adults, lifetime history of heavy cannabis use was associated with lower brain activation during a working memory task. These findings identify negative outcomes associated with heavy lifetime cannabis use and working memory in healthy young adults that may be long lasting.

PMID:39874032 | DOI:10.1001/jamanetworkopen.2024.57069

Arch Environ Occup Health. 2025 Jan 28:1-5. doi: 10.1080/19338244.2025.2451903. Online ahead of print.

ABSTRACT

Following a legionnaire’s disease outbreak in Barcelona in 2022, sport fields’ sprinklers were identified as potential sources of Legionella infection. The Agency of Public Health of Barcelona inspected all 40 urban municipal sports fields in the city. Legionella was found in 55% of them, including Legionella pneumophila serotype 1 in 11 samples. There were no statistically significant differences for Legionella detection according to the installation characteristics.These findings prompted the implementation of a set of preventive measures for risk mitigation and a specific control plan for sport fields.

PMID:39874031 | DOI:10.1080/19338244.2025.2451903

Future Cardiol. 2025 Jan 28:1-9. doi: 10.1080/14796678.2025.2458414. Online ahead of print.

ABSTRACT

INTRODUCTION: Decreased left atrial appendage emptying velocity (LAAV) is a marker for thrombus formation. This study evaluates the association between LAAV and inflammatory indices in non-valvular atrial fibrillation (AF) patients.

METHODS: The study population was 1428 patients with AF, 875 of whom enrolled. Based on the LAAV, patients were divided into three groups of 262 patients with a velocity of <25 cm/s, 360 patients with a velocity of 25 to 55 cm/s, and 253 patients with a velocity of >55 cm/s to assess and compare in terms of inflammatory indices, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, systemic immune inflammation index, neutrophil – to – platelet ratio and white blood cell-to-platelet ratio (WPR).

RESULTS: There was no statistical difference in the level of inflammatory indices between the three groups, and none of them were related to LAAV (p > .05) except WPR with a weak negative correlation (p = 0.01, r = -0.10). Patients with lower LAAV were found to have a higher age (p = 0.001), decreased left ventricular ejection fraction (p = 0.001) and greater left atrial volume index (p = 0.001).

CONCLUSION: This study did not show any association between inflammatory indices and LAAV in non-valvular AF patients except for the WPR.

PMID:39874020 | DOI:10.1080/14796678.2025.2458414

Asian Pac J Cancer Prev. 2025 Jan 1;26(1):347-358. doi: 10.31557/APJCP.2025.26.1.347.

ABSTRACT

OBJECTIVE: The case-control study aims to identify the potential risk and protective factors contributing to breast cancer risk in the high-incidence Aizawl population and the low-incidence Agartala population, using age-specific prevalence data of established reproductive factors and body mass index (BMI) among healthy women.

METHODS: A risk profile survey was conducted on asymptomatic women aged 30-64 in Aizawl and Agartala towns. Data was analysed using SPSS software. A descriptive statistical analysis characterised variable distribution, and bivariate inferential analyses of variable differences including birth cohort study across two states were conducted. Logistic regression determined odds ratios of mean values of reproductive factors and BMI.

RESULTS: The study reports that in Aizawl, a high prevalence of delayed marriages, late pregnancies, postmenopausal obesity and family history are potential risk factors for breast cancer in women, while an elevated mean age at menarche, high parity, and extended breastfeeding are protective factors. Conversely, in Agartala, early marriage, early first childbirth, high parity, prolonged breastfeeding, and healthy BMI are associated with low breast cancer risk in women. The study underscores the potential risk factors of early menarche and an extended reproductive period for women in Agartala.

CONCLUSION: The study emphasizes the importance of conducting age-specific prevalence studies in healthy women to identify critical risk and protective factors for breast cancer. Such information is crucial for healthcare professionals to develop prevention strategies, raise public awareness, and facilitate early detection of breast cancer in different populations. The study results will also set the stage for more extensive research on risk and protective factors for breast cancer in the Northeast region of India.

PMID:39874018 | DOI:10.31557/APJCP.2025.26.1.347

Asian Pac J Cancer Prev. 2025 Jan 1;26(1):293-299. doi: 10.31557/APJCP.2025.26.1.293.

ABSTRACT

OBJECTIVE: To assess the attitude and practices towards the Tobacco Cessation Counselling and Nicotine Replacement Therapy and identify the possible barriers towards the implementation of these practices amongst Private dental practitioners of North, India. Methodology: A cross sectional web based survey using 33 item pre-tested self administered questionnaire was conducted. A total of 250 valid responses were received and were available for analysis. Using the statistical package SPSS Version 23 the statistical analysis was done. The survey results was disseminated in accordance with the CHERRIES criteria for sharing E-survey results.

RESULTS: There was a response rate of 78.12 %. 69% of the subjects were offering tobacco cessation counseling while only 20.4% were actually practicing NRT. 52% believed that NRT along with counseling increases the rate of successful quitting the habit. 98% believed that they lacked formal training to introduce NRT for patients.

CONCLUSION: Though study subjects had a positive attitude towards tobacco cessation and Nicotine Replacement Therapy, it does not reflect their current practice. Dental practitioners must get ongoing education in order to enhance their skills in prescription NRT, as a major obstacle to providing NRT is a lack of formal training.

PMID:39874012 | DOI:10.31557/APJCP.2025.26.1.293