Nevin Manimala

J Prim Care Community Health. 2024 Jan-Dec;15:21501319241276780. doi: 10.1177/21501319241276780.

ABSTRACT

OBJECTIVES: Poor Food security (FS) is associated with risk of diet-related diseases and rising healthcare costs. Produce Prescription Interventions (PRx) are emerging clinical tools to improve FS and diet quality, but their impact in families with children is not well established. This study evaluates the impact of a pediatric PRx on FS and nutrition-related behaviors.

METHODS: Adult caregivers of children (0-18) were enrolled within a 6-month produce delivery and nutrition education intervention. A validated food security survey was administered pre/post intervention to determine FS scores and “Food Secure” status. Statistical analyses tested pre-post differences in FS scores and proportion of scores within the “Food Secure” range. Semi-structured interviews were performed post-intervention to explore families’ experiences with low FS and healthy behaviors and were thematically analyzed.

RESULTS: Between October 2021 and December 2022, 82 families were enrolled, 65 completed FS survey at baseline and 54 completed it at post-intervention. FS scores improved post-intervention (P < .05) and a greater proportion of household- and child-level scores fell within the “Food Secure” range post-intervention (P < .05). Twenty-eight interviews were analyzed. Three salient themes were identified: (1) value of healthcare-based screening and intervention, (2) food and education motivate behavior change, and (3) perceptions of post-intervention lifestyle sustainability.

CONCLUSIONS: Participation in the PRx was associated with improvements in FS and nutrition-related attitudes and behaviors. PRx can be implemented by health systems to improve FS and health behaviors associated with risk for diet-related diseases. Longer-term support may be needed to maintain healthy behavior changes associated with PRx participation.

PMID:39498605 | DOI:10.1177/21501319241276780

Ann Ig. 2025 Jan-Feb;37(1):84-96. doi: 10.7416/ai.2024.2659.

ABSTRACT

AIM: The lack of health professionals and the physicians’ migration trend represents a challenging issue for the health systems’ sustainability worldwide. The current study aims to evaluate the intentions of Italian medical students to pursue their own careers abroad by investigating the push and pull factors of migration.

SUBJECT AND METHODS: A cross-sectional study was performed among Italian medical students through a self-administered questionnaire. Primary and secondary outcomes were established as the intention of moving abroad after graduation and knowledge about residency programmes, application, quality training and remuneration in the country of interest. Descriptive analysis for all variables and univariable and multivariable regression for primary and secondary outcomes were performed.

RESULTS: Overall, 307 medical students took part in the study. More than half of the sample considered moving abroad after graduation, mainly to find a higher quality training programme. Regression analysis highlighted a significant association between the primary outcome and general personal and professional reasons, as well as previous experiences abroad, whereas bureaucratic procedures were perceived as the main barrier. Perceived better knowledge about residency programmes and quality of training related to sources of information such as the Internet (blogs, forums, websites) and medical associations.

CONCLUSION: Retention policies are necessary to meet the expectations and requests of future generations of doctors by allocating financial resources to offer high-quality training and broad career opportunities, together with appropriate wages, as crucial factors for discouraging the migration of healthcare professionals.

PMID:39498548 | DOI:10.7416/ai.2024.2659

Pharmacotherapy. 2024 Nov 5. doi: 10.1002/phar.4622. Online ahead of print.

ABSTRACT

Cannabinoids have emerged as a potential treatment for obstructive sleep apnea (OSA). This systematic review aimed to summarize the efficacy and safety of cannabinoids to treat OSA. Databases including Ovid MEDLINE, EMBASE, Scopus, PsycINFO, and International Pharmaceutical Abstracts were searched; experimental and observational studies were eligible for inclusion. One-hundred seventy unique records were screened, and nine studies included: five full-text studies and four published abstracts. The five full-text studies were judged for quality appraisal: two studies deemed at low risk for bias, one study deemed to have some concerns for bias, and two studies deemed to have high risk for bias. Seven of nine total studies were experimental designs and evaluated dronabinol, and the other two studies were observational designs evaluating cannabis. The range of cannabinoid therapy duration spanned from 1 to 6 weeks, and the median duration was 3 weeks. Eight of nine total studies reported statistically significant, positive OSA outcomes due to cannabinoid therapy including reductions in the apnea hypopnea index and improvements in patient-reported daytime sleepiness scales. Between 70% and 80% of study participants reported neuropsychiatric and gastrointestinal adverse events attributable to cannabinoids. The American Academy of Sleep Medicine does not recommend using cannabinoids to treat OSA due to a lack of long-term safety and efficacy data. This systematic review found similar limitations, with the median cannabinoid treatment duration being only 3 weeks. Adequately powered experimental trials over longer time frames are necessary to more completely assess the long-term efficacy and safety of cannabinoids in the treatment of OSA and its effects on common comorbid conditions, such as obesity and cardiovascular disease.

PMID:39498540 | DOI:10.1002/phar.4622

Eur J Psychotraumatol. 2024;15(1):2420464. doi: 10.1080/20008066.2024.2420464. Epub 2024 Nov 5.

ABSTRACT

Background: Research on the prevalence of ICD-11-based complex posttraumatic stress disorder (CPTSD) in nationally representative samples is lacking, with no such studies conducted considering national Polish samples until now.Objectives: The primary aim of this study was to explore profiles of study participants in terms of either PTSD or CPTSD symptoms regarding to ICD-11 diagnosis with the aid of latent profile analysis. We also investigated the relationship between the types and cumulative number of adverse childhood experiences (ACEs) with the probability of CPTSD rate in a national sample of Poles.Methods: A representative sample of Polish adults (n = 3,557) participated in this study. ACEs were assessed using the Adverse Childhood Experiences Questionnaire, while the core features of PTSD and CPTSD were measured using the International Trauma Questionnaire.Results: The findings showed a 11% prevalence rate of probable CPTSD in the studied sample of Poles. Sexual abuse, emotional neglect, physical neglect and having the experience of a mentally ill household member were the most significant predictors of potential diagnosis. Furthermore, significant differences concerning lifestyle data were observed in the group of participants with CPTSD.Conclusions: The current rate of probable CPTSD in Poland is substantially higher than the respective data reported for other countries. We also noted that the ICD-11 diagnosis of CPTSD may not apply to all cultural environments. Finally, it was observed that the ACEs – CPTSD association may depend both on the ACEs types as well as on their overall cumulative character.

PMID:39498533 | DOI:10.1080/20008066.2024.2420464

Phys Chem Chem Phys. 2024 Nov 5. doi: 10.1039/d4cp03447c. Online ahead of print.

ABSTRACT

Dynamical control of reactivity for the deazetization of endo,endo-9,10-diazatetracyclo[3.3.2.0^2,4.0^6,8]dec-9-ene (3) is studied using on-the-fly quasi-classical trajectory (QCT) calculations at the density functional theory (DFT) level. Two degenerate homotropilidenes, 4 and 5, are formed simultaneously from a single transition state (TS). The ratio of the cyclohexadienyl substituted product, 4, and the dynamical product, i.e. bridgehead substituted product, 5, can be neatly controlled by tuning the topology of the potential energy surface (PES). A steep descent post-TS favors the cyclohexadienyl substituted product while a shallow descent increases the dynamical outcome. Chemical demonstration of the same is achieved by symmetrical and asymmetrical substitution of functional groups along the cleaving (C3-C4) bond. Asymmetric mono-functionalization makes the PES broader, thereby reducing the slope post-TS. This creates a favourable situation for the dynamical products, 5b-5d, to become the major ones. On the contrary, symmetric bi-functionalization makes the cyclohexadienyl substituted product, 4m-4o, overwhelmingly (>85%) predominating. As a corollary to this phenomenon, substitution of the C3-C4 bond by the heavier isotopologues of H/C restricts its motion along the IRC path by the Newtonian kinetic isotope effect. This facilitates bond-opening along the C10-C11 dynamical pathway. Hence, for isotopic substitution, the situation is reversed and the bifunctionalized 3 is more dynamically activated. Simultaneous substitution by the heavier isotopologue of C and H causes deviation from the geometric mean of individual isotopic substitution towards the dynamical product, 5. Therefore, the dynamic control in 3 becomes prominent either via functional group asymmetry or through a Newtonian kinetic isotope effect for symmetric bifunctionalization.

PMID:39498517 | DOI:10.1039/d4cp03447c

Integr Cancer Ther. 2024 Jan-Dec;23:15347354241296810. doi: 10.1177/15347354241296810.

ABSTRACT

BACKGROUND: Integrative Oncology (IO) interventions may decrease physical, psychological, and social distress related to cancer and its treatments. Little is known about the frequency and predictors of IO referral for symptom management for cancer rehabilitation inpatients.

METHODS: A retrospective review was performed of patients with cancer who underwent inpatient rehabilitation at a specialized tertiary cancer center from 5/2016 to 3/2020. Patient demographics and IO consultation details, including patient-reported outcome measures of symptom burden using ESAS-FS and functional status using the Activity Measure for Post-Acute Care “6 clicks,” were extracted. Descriptive summary statistics and logistic regression were used to analyze the data.

RESULTS: Out of 1196 inpatient rehabilitation admissions, 100 (8.4%) were referred to IO. The Activity Measure for Post-Acute Care “6 clicks” basic mobility admission scores were significant at a 1-point difference between the intervention and control group (39.5 vs 40.8, P < .05); both scores equate to a ˃50% degree of functional impairment. Referred patients were younger (62, P = .02) and Hispanics or Latinos (P = .02). The top symptoms for IO consultation included pain (N = 73), integrative approach (N = 41), relaxation (N = 38), and stress/anxiety (N = 33). Patients who reported a baseline symptom score ≥ 1 in the ESAS-FS, had both statistically (P < .05) and clinically significant improvements (≥1 point change) for pain, fatigue, well-being, anxiety, and sleep after massage therapy.

CONCLUSION: Cancer rehabilitation inpatients were commonly referred to IO to address pain, with observed improvements across multiple symptoms with massage therapy. Lower mobility scores and younger patients received significantly higher referrals to IO. Larger trials are needed to characterize the effects of IO interventions on the inpatient rehabilitation of patients with cancer.

PMID:39498495 | DOI:10.1177/15347354241296810

Internet Interv. 2024 Oct 16;38:100780. doi: 10.1016/j.invent.2024.100780. eCollection 2024 Dec.

ABSTRACT

OBJECTIVE: Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence.

METHOD: A longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis.

RESULTS: Participants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58-62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42-46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14.

CONCLUSIONS: Guided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

PMID:39498477 | PMC:PMC11533681 | DOI:10.1016/j.invent.2024.100780

Technometrics. 2022;64(2):241-252. doi: 10.1080/00401706.2021.1952900. Epub 2021 Dec 16.

ABSTRACT

We develop a real-time anomaly detection method for directed activity on large, sparse networks. We model the propensity for future activity using a dynamic logistic model with interaction terms for sender- and receiver-specific latent factors in addition to sender- and receiver-specific popularity scores; deviations from this underlying model constitute potential anomalies. Latent nodal attributes are estimated via a variational Bayesian approach and may change over time, representing natural shifts in network activity. Estimation is augmented with a case-control approximation to take advantage of the sparsity of the network and reduces computational complexity from O(N ²) to O(E), where N is the number of nodes and E is the number of observed edges. We run our algorithm on network event records collected from an enterprise network of over 25,000 computers and are able to identify a red team attack with half the detection rate required of the model without latent interaction terms.

PMID:39498474 | PMC:PMC11534301 | DOI:10.1080/00401706.2021.1952900

Health Sci Rep. 2024 Nov 3;7(11):e70137. doi: 10.1002/hsr2.70137. eCollection 2024 Nov.

ABSTRACT

BACKGROUND AND AIMS: This network meta-analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy.

METHODS: We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk-of-bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta-analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically.

RESULTS: A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single-site surgery-laparoscopic-assisted vaginal hysterectomy (LESS-LAVH) demonstrated superior outcomes in terms of complications, infections, and 24-h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time.

CONCLUSION: LESS-LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high-quality, large-scale, multicenter RCTs.

PMID:39498464 | PMC:PMC11532236 | DOI:10.1002/hsr2.70137

NAR Genom Bioinform. 2024 Nov 4;6(4):lqae146. doi: 10.1093/nargab/lqae146. eCollection 2024 Sep.

ABSTRACT

Epigenetic deregulation through altered DNA methylation is a fundamental feature of tumorigenesis, but tumor data from bulk tissue samples contain different proportions of malignant and non-malignant cells that may confound the interpretation of DNA methylation values. The adjustment of DNA methylation data based on tumor purity has been proposed to render both genome-wide and gene-specific analyses more precise, but it requires sample purity estimates. Here we present PureBeta, a single-sample statistical framework that uses genome-wide DNA methylation data to first estimate sample purity and then adjust methylation values of individual CpGs to correct for sample impurity. Purity values estimated with the algorithm have high correlation (>0.8) to reference values obtained from DNA sequencing when applied to samples from breast carcinoma, lung adenocarcinoma, and lung squamous cell carcinoma. Methylation beta values adjusted based on purity estimates have a more binary distribution that better reflects theoretical methylation states, thus facilitating improved biological inference as shown for BRCA1 in breast cancer. PureBeta is a versatile tool that can be used for different Illumina DNA methylation arrays and can be applied to individual samples of different cancer types to enhance biological interpretability of methylation data.

PMID:39498434 | PMC:PMC11532792 | DOI:10.1093/nargab/lqae146