Nevin Manimala

Med Decis Making. 2024 Dec 24:272989X241305142. doi: 10.1177/0272989X241305142. Online ahead of print.

ABSTRACT

BACKGROUND: In the United States, human papillomavirus (HPV) vaccination among 27- to 45-y-olds (mid-adults) is recommended based on shared clinical decision making with a health care provider. We developed a patient decision aid tool to support the implementation of this mid-adult HPV vaccination guideline. The purpose of this study was to evaluate the effect of a patient decision aid tool for HPV vaccination, HPV DECIDE, compared with an information fact sheet among mid-adults who have not received the HPV vaccine.

METHOD: Participants were recruited between December 2023 and January 2024. We used a randomized Solomon, 4-group, pretest/posttest design with mid-adults aged 27 to 45 y who were unvaccinated for HPV and balanced based on sex (n = 612). The primary outcome was decisional conflict. Intermediate outcomes included knowledge, behavioral expectancies, self-efficacy, and perceived risk. Variables were measured using validated scales. Pretest sensitization was not present; intervention and control groups were compared. Fixed-effects inverse-variance weighting was used to pool effect estimates and determine meta-analytic statistical significance across tests with and without pretest controls.

RESULTS: Participants in the intervention group had significantly lower total decisional conflict scores (B = -3.58, P = 0.007) compared with the control group. Compared with the control group, participants in the intervention group showed higher knowledge (B = 0.48, P = 0.020), greater intention to receive (B = 0.196, P = 0.049) and discuss the HPV vaccine (B = 0.324, P ≤ 0.001), and greater self-efficacy about HPV vaccine decision making (B = 3.28, P = 0.043). There were no statistically significant results for perceived risks of HPV infection.

CONCLUSIONS: The HPV DECIDE tool for mid-adult HPV vaccination shows promise for immediate reductions in decisional conflict and improvement in knowledge, intentions, and self-efficacy about the HPV vaccine. Future studies are warranted to evaluate the effectiveness of this patient decision aid tool in real-world settings.

HIGHLIGHTS: Shared clinical decision making is recommended for HPV vaccination with mid-adults.A patient decision aid for HPV vaccination reduced decisional conflict for mid-adults.The HPV vaccine patient decision aid was acceptable to mid-adults.

PMID:39717960 | DOI:10.1177/0272989X241305142

An Sist Sanit Navar. 2024 Dec 24;47(3):e1093. doi: 10.23938/ASSN.1093.

ABSTRACT

BACKGROUND: This study examines the relationship between unmet healthcare needs and employment status, with a focus on how this relationship was influenced by the Spanish economic recession of 2008-2012.

METHODS: Data were obtained from the Spanish National Health Survey for 2006 and 2011-2012. The outcome variable was the presence of unmet healthcare needs, describing its reasons. The analysis included the period (pre-crisis/crisis), demographic variables (sex, age, Spanish citizenship), employment status, social factors (level of education, marital status, social-class), and health indicators (self-assessed health, chronic conditions, and limitations). Logistic regression was used to predict unmet health needs based on the period, employment status, and control variables.

RESULTS: The frequency of unmet healthcare needs was low and decreased further during the crisis (5% pre-crisis vs 3% during the crisis). Unmet healthcare needs were more strongly associated with health status than with employment status. However, among the unemployed, unmet healthcare needs increased during the crisis compared to the pre-crisis.

CONCLUSIONS: The most vulnerable groups, characterized by higher unmet healthcare needs, included women, individuals with lower levels of education, and those in poorer health. These groups may require more targeted attention. These findings should be interpreted in the context of the Spanish National Health System, which is fully decentralized and provides healthcare and protection to all residents.

PMID:39717952 | DOI:10.23938/ASSN.1093

Pacing Clin Electrophysiol. 2024 Dec 24. doi: 10.1111/pace.15128. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary vein isolation (PVI) has been established as an effective management option for symptomatic paroxysmal atrial fibrillation (PAF). We aimed to explore the role of P-wave parameters in a 12-lead electrocardiogram (ECG) in predicting the success of repeat PAF ablation.

METHODS: We enrolled consecutive patients who underwent a second AF ablation procedure for PAF in a UK tertiary center after an index ablation conducted between 2018 and 2019 and a repeat ablation up to 2021. A digital 12-lead ECG was recorded with a 1-50-Hz bandpass filter applied. P-wave duration (PWD), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured before and after the procedure. Changes were correlated with the 12-month clinical outcome. Procedural success was freedom from ECG-documented AF up to 12 months following ablation.

RESULTS: Study criteria were satisfied by 72 patients, of which 43 (60%) had successful repeat PVI at 12 months. The mean age is 65, and 47 (65%) were males. The demographics were comparable between both study arms. PWD decreased after successful repeat ablations (136.7 to 124.6 ms, p = 0.01) and failed repeat ablations (135.4 to 125.3 ms, p = 0.009) without a significant change between both arms. PMV and PWDisp did not change significantly after both study arms. PTFV1 significantly decreased after successful repeat ablations (-3.1 to -4.4 mm.s, p = 0.005) without a significant change after failed ablations (-2.9 to -2.7 mm.s, p = 0.42). Changes were statistically significant between both arms (p = 0.004).

CONCLUSION: PTFV1 reduction following the second AF ablation was correlated with successful repeat AF ablation at 12 months.

PMID:39717950 | DOI:10.1111/pace.15128

Pacing Clin Electrophysiol. 2024 Dec 24. doi: 10.1111/pace.15127. Online ahead of print.

ABSTRACT

BACKGROUND: Pacemaker recipients demonstrate a higher prevalence of atrial fibrillation (AF), yet the regular ventricular activation in pacemaker-dependent patients with AF presents a substantial diagnostic challenge.

METHODS: A total of 310 medical practitioners completed a brief, validated survey consisting of three electrocardiograms displaying AF with ventricular pacing. Participants were instructed to identify the underlying rhythm.

RESULTS: Cardiologists outperformed all other groups with 69% correct responses, followed by emergency physicians (33%) and internists (24%). The poorest performance was observed among primary care physicians (14%) and medical interns (12%) (p < 0.0001). The comparison between groups revealed a statistically significant difference between cardiologists and non-cardiologists (p < 0.001).

CONCLUSION: The detection of AF in patients with ventricular-paced rhythm remains a significant diagnostic challenge, with notable gaps even among cardiologists. It is imperative to educate physicians that AF in this context may not present with the typical irregular rhythm. Routine interrogation of cardiac devices in cases where the rhythm is unclear can facilitate a timely and accurate diagnosis of this concealed arrhythmia.

PMID:39717948 | DOI:10.1111/pace.15127

Biotechnol Bioeng. 2024 Dec 24. doi: 10.1002/bit.28906. Online ahead of print.

ABSTRACT

An open-source modeling platform, called Anaerobic Digestion Model No. 1 Fast (ADM1F), is introduced to achieve fast and numerically stable simulations of anaerobic digestion processes. ADM1F is compatible with an iPython interface to facilitate model configuration, simulation, data analysis, and visualization. Faster simulations and more stable results are accomplished by implementing an advanced open-source library of numerical methods called Portable Extensive Toolkit for Scientific Computation (PETSc) to solve the ADM1 system of equations. Leveraging PETSc, ADM1F can consistently complete a steady-state simulation under 0.2 s, over 99% faster than a benchmark ADM1 model implemented with MATLAB while achieving agreement of model outputs within 1% of those obtained with the benchmark model. For dynamic simulations, however, ADM1F has a computational speed advantage only when the influent characteristics update more frequently than every 4 h. The ability of ADM1F to be useful as a tool to study anaerobic digestion systems is demonstrated through two example implementations of ADM1F: (1) a two-phase co-digestion scenario evaluating the impact of the organic loading rate and the substrate composition on reactor performance and stability, and (2) a conventional digester scenario assessing the effectiveness of recovery strategies after disruptions that led to instability. These examples demonstrate how the high simulation speed and the convenience of the iPython interface allow ADM1F to complete complex analyses within minutes, much faster than computational strategies currently reported in the literature.

PMID:39717912 | DOI:10.1002/bit.28906

IJID Reg. 2024 Nov 20;14:100495. doi: 10.1016/j.ijregi.2024.100495. eCollection 2025 Mar.

ABSTRACT

OBJECTIVES: We examined shifts in labor productivity and their economic ramifications among adult patients with long COVID in Japan.

METHODS: A total of 396 patients were categorized into three groups based on symptom progression: non-long COVID, long COVID recovered, and long COVID persistent. Patient-reported outcomes were assessed at three time intervals: 3, 6, and 12 months after COVID-19 diagnosis. Labor productivity was gauged through presenteeism and absenteeism, measured using the World Health Organization Health and Work Performance Questionnaire.

RESULTS: Long COVID was observed in 52.7% of patients, and 29.3% of all the patients continued to experience long COVID symptoms 1 year after diagnosis. At all three time points (3, 6, and 12 months after diagnosis), the long COVID persistent group showed a statistically significant difference in absolute presenteeism compared with the non-long COVID and long COVID recovered groups (P <0.01). Economic loss owing to decrease in labor productivity was calculated as $21,659 per year in the long COVID persistent group and $9008 per year in the long COVID recovered group (P <0.01).

CONCLUSION: The study’s results revealed a notable decline in labor productivity over time, underscoring the importance of early detection and intervention to mitigate the socio-economic repercussions of long COVID, in addition to its health implications.

PMID:39717862 | PMC:PMC11664411 | DOI:10.1016/j.ijregi.2024.100495

Front Cell Dev Biol. 2024 Dec 9;12:1446363. doi: 10.3389/fcell.2024.1446363. eCollection 2024.

ABSTRACT

INTRODUCTION: T-cadherin, a non-canonical member of the cadherin superfamily, was initially identified for its involvement in homophilic recognition within the nervous and vascular systems. Apart from its adhesive function, T-cadherin acts as a receptor for two ligands: LDL, contributing to atherogenic processes, and HMW adiponectin, a hormone with well-known cardiovascular protective properties. However, the precise role of T-cadherin in adipose tissue remains elusive. Previously, we generated Cdh13^∆Exon3 mice lacking exon 3 in the Cdh13 gene, which encodes the T-cadherin protein, and characterized their phenotype.

METHODS: Using wild-type (WT) and T-cadherin-deficient mice (Cdh13ΔExon3), we isolated and cultured mesenchymal stem cells to explore the role of T-cadherin in adipogenic differentiation. The experimental approaches employed include culturing cells under standard or adipogenic conditions, performing Oil Red O and Nile Red staining followed by quantitative analysis, conducting rescue experiments to reintroduce T-cadherin using lentiviral constructs in T-cadherin-deficient cells combined with automated adipocyte differentiation quantification via a neural network. Additionally, Western blotting, ELISA assays, and statistical analysis were utilized to verify the results.

RESULTS: In this study, we demonstrate for the first time that T-cadherin influences the adipogenic differentiation of MSCs. The presence of T-cadherin dictates distinct morphological characteristics in MSCs. Lack of T-cadherin leads to spontaneous differentiation into adipocytes with the formation of large lipid droplets. T-cadherin-deficient cells (T-/- MSCs) exhibit an enhanced adipogenic potential upon induction with differentiating factors. Western Blot, ELISA assays, and rescue experiments collectively corroborate the conclusion that T-/- MSCs are predisposed toward adipogenic differentiation. We carried out an original comparative analysis to explore the effects of T-cadherin ligands on lipid droplet accumulation. LDL stimulate adipogenic differentiation, while T-cadherin expression mitigates the impact of LDL on lipid droplet accumulation. We also examined the effects of both low molecular weight (LMW) and high molecular weight (HMW) adiponectin on lipid droplet accumulation relative to T-cadherin. LMW adiponectin suppressed lipid droplet accumulation independently of T-cadherin, while the absence of T-cadherin enhanced susceptibility to the suppressive effects of HMW adiponectin on adipogenesis.

DISCUSSION: These findings shed light on the role of T-cadherin in adipogenic differentiation and suggest an interplay with other receptors, such as LDLR and AdipoRs, wherein downstream signaling may be modulated through lateral interactions with T-cadherin.

PMID:39717846 | PMC:PMC11663858 | DOI:10.3389/fcell.2024.1446363

Arthroplast Today. 2024 Dec 7;30:101574. doi: 10.1016/j.artd.2024.101574. eCollection 2024 Dec.

ABSTRACT

BACKGROUND: Aseptic loosening is the most common aseptic failure modality following total knee arthroplasty. Recent literature suggests that the implant-cement interface is the “weak-link” in fixation and lipid contamination may drive this debonding pattern. Therefore, the purpose of this study was to determine if the “double-butter” technique would significantly decrease lipid contamination of the tibial tray.

METHODS: Transparent acrylic models of 7 different tibial baseplates were created to allow for direct visualization of fluid contamination of the implant-cement interface during experimental cementation. Three cementation techniques were then employed in triplicate for each implant: coating only the tibia (“single butter”) and coating of the tibia and baseplate (with and without keel included; “double-butter”). A dye was added centrally to simulate lipid contamination. After each trial, the degree of implant-cement contamination was calculated. Standard statistical analyses were conducted.

RESULTS: With the double-butter technique, there was a significant reduction in contamination for all studied implant designs (range: 0%-7%; P < .05) and contamination was eliminated when the entire implant was coated prior to implantation. The single-butter technique resulted in contamination of 16%-43% of the tibial undersurface. There were significant differences in percent contamination between component designs (P < .05).

CONCLUSIONS: Cementation technique and implant design each influenced baseplate lipid contamination. While significant differences were noted between keel geometries, we found that the double-butter technique effectively eliminated baseplate contamination, even in the most susceptible designs in this study. We therefore advocate for the incorporation of the double-butter technique to limit lipid contamination and potentially reduce aseptic tibial loosening.

PMID:39717839 | PMC:PMC11665463 | DOI:10.1016/j.artd.2024.101574

Front Glob Womens Health. 2024 Dec 9;5:1423639. doi: 10.3389/fgwh.2024.1423639. eCollection 2024.

ABSTRACT

INTRODUCTION: Globally, maternal mortality is a major public health problem mainly due to a lack of access to skilled care during childbirth. Maternity waiting homes (MWHs) play a critical role in accessing emergency obstetric care for pregnant women during childbirth. However, available studies show inconsistent findings about women’s utilization of maternity waiting homes. Therefore, the aim of this review was to identify the pooled prevalence of women’s utilization of maternity waiting homes and its associated factors in Ethiopia.

METHOD: We used the PRISMA guidelines to report the review. We searched for potentially eligible studies in Google Scholar, PubMed, Cochrane Library, and Google using Medical Subject Heading terms and keywords. The retrieved articles were screened and assessed for quality. The heterogeneity across studies was checked using Cochran’s Q test and I ² statistics. The pooled levels of women’s utilization and associated factors were analyzed using meta-analysis. The publication bias was measured using the funnel plot and Egger’s test. The subgroup analysis and sensitivity analysis were carried out to identify the studies with high effects.

RESULTS: A total of 11 eligible studies with 11,784 study participants were included. The utilization of MWHs was in the range of 7%-42.5%. The pooled estimate of women’s utilization of maternity waiting homes was 22.49%. Factors associated with utilization included women’s decision-making power, access to transport, walking distance to the nearest facility, and having a companion.

CONCLUSION AND RECOMMENDATION: The overall prevalence of maternity waiting home utilization in Ethiopia is low, with significant variation across regions. Health sector program administrators should focus on both the consumer and healthcare system.

SYSTEMATIC REVIEW REGISTRATION: The review protocol was registered in PROSPERO (number CRD42021243526).

PMID:39717798 | PMC:PMC11663854 | DOI:10.3389/fgwh.2024.1423639

Front Vet Sci. 2024 Dec 9;11:1468906. doi: 10.3389/fvets.2024.1468906. eCollection 2024.

ABSTRACT

The African swine fever (ASF) epidemic has severely challenged the Philippines’ swine industry since 2019. The National African Swine Fever Prevention and Control Program (NASFPCP), launched in 2021, aims to provide guidance for managing ASF through surveillance, monitoring, and swine repopulation. This study evaluates the effectiveness of post-outbreak disinfection protocols and government-mandated measures for repopulation standard. Surveillance data from three repopulation phases-(I) depopulation, cleaning, and disinfection; (II) downtime (20 days); and (III) sentinel animals (40 days)-were collected from February 2020 to December 2021 in the province of Batangas. Time-to-detection of positive events were analyzed for different farm types, seasons, or location using survival analysis modeling. Probability of detecting infected farms at different sampling times was estimated in terms of sensitivity of the sampling time. Data from 145 swine farms, including 99 backyard and 46 commercial farms, revealed positive rates of 10.1 and 8.7%, respectively. The failure rate during repopulation surveillance was 9.66%, whereas 90.34% farms remained ASF negative. Sensitivity estimate increased from 18-21 to 89% by day 27, with sentinel animals on that day exhibiting the highest estimated sensitivity. This highlights the importance of sentinel pigs in the NASFPCP for effective ASF control in the Philippines. Survival analysis showed no statistically significant differences in the results between either farm type, season, or municipality level. Geographic mapping of surveyed farms and those with positive detections identified high-risk locations including San Juan and Lipa City as key areas of concern. Enhancing targeted surveillance is critical for improving an early ASF detection and national response in the Philippines.

PMID:39717795 | PMC:PMC11663853 | DOI:10.3389/fvets.2024.1468906