Nevin Manimala

Arch Gerontol Geriatr. 2024 Nov 25;130:105703. doi: 10.1016/j.archger.2024.105703. Online ahead of print.

ABSTRACT

INTRODUCTION: Blood-based biomarkers such as plasma neurofilament light chain (pNfL) are crucial biomarkers for Alzheimer’s disease (AD). Additionally, neuroimaging techniques such as tensor-based morphometry (TBM), which identify structural changes in the brain, can provide valuable insights into AD pathophysiology. However, the role of genetics in linking the blood based biomarkers and imaging findings has not been well understood. Therefore, we aimed to investigate whether the polygenic hazard score (PHS), affects the association between neurofibrillary tangles and neuritis plaques and brain imaging findings.

METHODS: Using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database, we enrolled all participants for whom a complete dataset of pNfL, PHS, and TBM was available. Using Python, we analyzed the associations between pNfL levels and the TBM data of 567 participants incluidng 152 cognitively normal individuals, 309 participants with mild cognitive impairment (MCI), and 106 patients with AD. We used a mediation analysis to identify the effect of PHS in how pNfL is associated with TBM measures.

RESULTS: We found a negative correlation between the accelerated TBM measure and NfL levels in both the MCI and AD groups. The pNfL concentration predicted both accelerated statistical and anatomical TMB measures in patients with MCI. Furthermore, PHS mediatedthe association between statistical TBM measures and NfL levels in AD patients, to the extent that the significant association between NfL and TBM measures disappeared after accounting for PHS.

CONCLUSION: We showed that although pNfL can predict the cognitiee decline and imaging findings in AD, this effect is mediated by the PHS. Therefore, PHS should be considered when investigating AD biomarkers and their corresponding imaging findings.

PMID:39631103 | DOI:10.1016/j.archger.2024.105703

Am J Public Health. 2025 Jan;115(1):75-82. doi: 10.2105/AJPH.2024.307867.

ABSTRACT

Immigration status and related policies have a significant impact on health outcomes. Yet major national health surveys currently provide little or no information about immigration status, rendering subgroups of noncitizens largely invisible. Even measures of citizenship, nativity, country of birth, and years in the United States, which provide critical information about immigration history, are not consistently included in national data sets. The main objections to asking directly about immigration status are that (1) such questions are too stigmatizing, risking lower response rates and inaccurate responses; and (2) answering the questions may expose respondents to possible immigration or criminal consequences. Our analysis shows that these objections are unfounded or can be mitigated. National health surveys have evolved over the past decades to include questions about mental health, substance use, sexual orientation, and gender identity-topics once assumed to be too stigmatizing to ask about, with possible negative legal consequences. We argue that the time has come to obtain more detailed information about immigration status as well as to consistently include the measures of immigration history mentioned so that we can better evaluate the health consequences of immigrant-related policy choices. (Am J Public Health. 2025;115(1):75-82. https://doi.org/10.2105/AJPH.2024.307867).

PMID:39631085 | DOI:10.2105/AJPH.2024.307867

Blood Adv. 2024 Dec 4:bloodadvances.2024013826. doi: 10.1182/bloodadvances.2024013826. Online ahead of print.

ABSTRACT

The prognostic impact of measurable residual disease (MRD) in acute myeloid leukemia (AML) is unequivocal; however, the optimal timepoint for achieving undetectable MRD is unclear. We retrospectively studied patients with newly diagnosed (ND) AML who achieved remission with frontline intensive chemotherapy and had MRD assessed by flow cytometry after induction (TP1) and after cycles 2 or 3 (TP2). Cases were grouped into MRD Neg/Neg, Pos/Neg or Pos/Pos at TP1 and TP2, respectively. Of 1980 patients with ND AML, 277 met inclusion criteria and were included in this analysis. The median relapse-free survival (RFS) was 73 months, 22 months, and 5 months for the MRD Neg/Neg, Pos/Neg and Pos/Pos groups, respectively (p < 0.01). There was a significant difference between the Neg/Neg and Pos/Neg groups (p = 0.05), suggesting benefit to early MRD negativity. Median overall survival (OS) was 81 months, 40 months, and 9 months, respectively (p < 0.01), but the difference between Neg/Neg and Pos/Neg was not statistically significant (p = 0.19). Landmark analysis demonstrated the benefit of SCT, particularly in Neg/Neg intermediate risk AML (median RFS not reached versus 15 months, p < 0.01). On multivariable analysis, MRD Pos/Neg was independently associated with a worse RFS compared with Neg/Neg (hazard ratio 1.73 [95% CI, 1.09 – 2.75], p = 0.02) but not for OS (p = 0.15). In conclusion, undetectable flow MRD after induction is associated with better RFS compared with undetectable MRD achieved later during consolidation. SCT benefitted patients with intermediate risk AML, regardless of MRD kinetics.

PMID:39631072 | DOI:10.1182/bloodadvances.2024013826

J Med Internet Res. 2024 Dec 4;26:e65541. doi: 10.2196/65541.

ABSTRACT

BACKGROUND: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear.

OBJECTIVE: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens.

METHODS: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups.

RESULTS: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28% lower likelihood of using the internet for health information (P<.001) and a 32.63% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21%, P<.001) and make appointments (10.03%, P=.006) and using wearable devices to track health (8.31%, P=.01).

CONCLUSIONS: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers.

PMID:39631070 | DOI:10.2196/65541

JMIR Form Res. 2024 Dec 4;8:e63035. doi: 10.2196/63035.

ABSTRACT

BACKGROUND: Nicotine is a highly addictive agent in tobacco products. On June 21, 2022, the US Food and Drug Administration (FDA) announced a plan to propose a rule to establish a maximum nicotine level in cigarettes and other combusted tobacco products.

OBJECTIVE: This study aimed to understand public perception and discussion of very low nicotine content (VLNC) on Twitter (rebranded as X in July 2023).

METHODS: From December 12, 2021, to January 1, 2023, we collected Twitter data using relevant keywords such as “vln,” “low nicotine,” and “reduced nicotine.” After a series of preprocessing steps (such as removing duplicates, retweets, and commercial tweets), we identified 3270 unique noncommercial tweets related to VLNC. We used an inductive method to assess the public perception and discussion of VLNC on Twitter. To establish a codebook, we randomly selected 300 tweets for hand-coding, including the attitudes (positive, neutral, and negative) toward VLNC (including its proposed rule) and major topics (13 topics). The Cohen κ statistic between the 2 human coders reached over 70%, indicating a substantial interrater agreement. The rest of the tweets were single-coded according to the codebook.

RESULTS: We observed a significant peak in the discussion of VLNC on Twitter within 4 days of the FDA’s announcement of the proposed rule on June 21, 2022. The proportion of tweets with a negative attitude toward VLNC was significantly lower than those with a positive attitude, 24.5% (801/3270) versus 37.09% (1213/3270) with P<.001 from the 2-proportion z test. Among tweets with a positive attitude, the topic “Reduce cigarette consumption or help smoking cessation” was dominant (1097/1213, 90.44%). Among tweets with a negative attitude, the topic “VLNC leads to more smoking” was the most popular topic (227/801, 28.34%), followed by “Similar toxicity of VLNC as a regular cigarette” (223/801, 27.84%), and “VLNC is not a good method for quitting smoking” (211/801, 26.34%).

CONCLUSIONS: There is a more positive attitude toward VLNC than a negative attitude on Twitter, resulting from different opinions about VLNC. Discussions around VLNC mainly focused on whether VLNC could help people quit smoking.

PMID:39631065 | DOI:10.2196/63035

J Med Internet Res. 2024 Dec 4;26:e48882. doi: 10.2196/48882.

ABSTRACT

BACKGROUND: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited.

OBJECTIVE: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication.

METHODS: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression.

RESULTS: Age had a negative effect on both perceived and objective comprehension-age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87).

CONCLUSIONS: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed).

PMID:39631064 | DOI:10.2196/48882

JMIR Cancer. 2024 Dec 4;10:e53229. doi: 10.2196/53229.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45-49 years (20%), patients of safety net health care facilities (42%), adults without insurance (44%), and other subgroups compared with national averages (72%). Given the evolving landscape of digital health care and trends in web-based health information-seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion-a key social determinant of health-and support equitable web-based interventions aimed at boosting CRC screening across diverse populations.

OBJECTIVE: This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults.

METHODS: In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018-2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression.

RESULTS: The sample included adults aged 45-75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70% (4029/5143) of participants reported CRC screening and 52% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95% CI 1.22-2.53), adults who accessed an OMR (OR 1.89, 95% CI 1.45-2.46), older individuals (OR 1.18, 95% CI 1.16-1.21), the insured (OR 3.69, 95% CI 2.34-5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95% CI 1.28-5.47). Individuals aged 65-75 years were significantly more likely (P<.001) to be screened (1687/1831, 91%) than those aged 45-49 years (190/610, 29%).

CONCLUSIONS: Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations.

PMID:39631060 | DOI:10.2196/53229

J Particip Med. 2024 Dec 4;16:e48194. doi: 10.2196/48194.

ABSTRACT

BACKGROUND: The COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals.

OBJECTIVE: We describe the intervention’s implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders.

METHODS: The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research.

RESULTS: In total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it “quite easy/very easy” to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders’ recommendations, the adjustability of the intervention, and the team’s emphasis on safety. However, Opal’s thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security-related institutional barriers.

CONCLUSIONS: The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/35760.

PMID:39631058 | DOI:10.2196/48194

Crit Care Med. 2024 Dec 4. doi: 10.1097/CCM.0000000000006532. Online ahead of print.

ABSTRACT

OBJECTIVES: The Sequential Organ Failure Assessment (SOFA) score originated as a tool for assessing organ dysfunction in critical illness but has expanded to become an outcome measure in clinical trials. We aimed to assess how the SOFA score was used as the primary or secondary endpoint of major randomized controlled trials (RCTs).

DATA SOURCES: Independent reviewers searched MEDLINE/PubMed, Scopus, and Embase databases.

STUDY SELECTION: Articles were selected when they fulfilled: 1) RCT; 2) SOFA score was primary or secondary endpoint; and 3) published in the Lancet, New England Journal of Medicine, or Journal of the American Medical Association.

DATA EXTRACTION: Data collection included study details, outcomes, statistical differences in SOFA score, choice of score statistics, timepoints of SOFA reporting, and how missing data and competing risks analysis were managed.

DATA SYNTHESIS: Twenty-three RCTs had SOFA score as outcome measure, eight used it as primary endpoint. Daily maximum SOFA was the key statistic in 11 RCTs, delta SOFA was used in eight, and mean SOFA in four. Mean SOFA was most frequently chosen as primary endpoint (4/8, 50%). There were 18 different outcome assessment timepoints, ranging from 1 to 28 days. Three RCTs reported statistically significant difference in SOFA between groups. Handling of missing SOFA scores was not described in ten of 23 RCTs. When described, it varied from study to study with variable imputation methods and variable accounting for the competing risk of mortality and ICU discharge.

CONCLUSIONS: There is major variability in the choice of summary statistic for SOFA score analysis and assessment timepoints, when using it as outcome measure in RCTs. There was either no information or great variability in the handling of missing values, use of imputation, and accounting for competing risk. The current use of SOFA scores in RCTs lacks sufficient reproducibility and statistical and methodological robustness.

PMID:39631051 | DOI:10.1097/CCM.0000000000006532

Hum Vaccin Immunother. 2024 Dec 31;20(1):2429235. doi: 10.1080/21645515.2024.2429235. Epub 2024 Dec 4.

ABSTRACT

This study aims to provide a comprehensive review of literature on pneumococcal disease burden in high-risk older adults aged ≥65 with focus on impact of comorbidities, long-term care facilities (LTCFs), antibiotic resistance, and vaccination policies across various countries. Research showed that the disease burden and the prevalence of antibiotic-resistant pneumococci was higher in the elderly, particularly those residing in LTCFs, and with comorbidities. These individuals are at high risk of infection with antibiotic-resistant serotypes 10A, 11A, and 15B. The vaccination strategies and national guidelines for pneumococcal vaccines in the elderly vary across countries. Some countries focus on single-dose strategies, while others recommend sequential vaccinations with varying intervals. Although vaccination policies are well-established for the elderly, they are not as well-established for high-risk elderly groups, and this review underscores the need for more tailored vaccination strategies for these groups.

PMID:39631047 | DOI:10.1080/21645515.2024.2429235