Nevin Manimala

Mil Med. 2024 Jul 24:usae368. doi: 10.1093/milmed/usae368. Online ahead of print.

ABSTRACT

INTRODUCTION: Military spouses play a key role in the military family and contribute to military readiness. Despite their influence, they are an understudied population. Previous research has identified military spouses as a vulnerable group considering their unique life stressors and high mental distress; thus, it is critical to identify potential protective factors for military spouses. However, there is a lack of research exploring the role of religious coping and resilience in mental health outcomes of military spouses. The purpose of this study was to evaluate the effect of religious coping on depression, anxiety, and stress, and the extent to which the effect is mediated by resilience.

MATERIALS AND METHODS: A total of 1,079 military spouses completed self-administered surveys online. The questionnaires assessed demographic factors, depression, anxiety, stress, religious coping, and resilience. Zero-order correlations and descriptive statistics were analyzed. Additionally, multiple linear regression was utilized to investigate the extent to which resilience mediated the relationship between religious coping and mental health outcomes.

RESULTS: The results indicate high levels of depression, anxiety, and stress among military spouses. Religious coping had significant effects on mental distress, such that increases in religious coping corresponded to decreases in depression (β = -3.30), anxiety (β = -1.89) and stress (β = -1.58). Mediation analyses indicated resilience significantly mediated the relationship between religious coping and depression (95% CI [-1.38, -.431]), anxiety (95% CI [-1.23, -.376]), and stress (95% CI [-1.328, -0.420]). For military spouses, religious coping was associated with increased resilience, which was subsequently associated with reduced mental distress.

CONCLUSIONS: This study draws attention to the role of religious coping and resilience in mental health outcomes for military spouses. Considering the role of military spouses in supporting service members, future research should explore how to strengthen military spouses’ religious coping and resilience to mitigate mental distress, thereby facilitating service member success and military readiness.

PMID:39046759 | DOI:10.1093/milmed/usae368

JAMA Psychiatry. 2024 Jul 24. doi: 10.1001/jamapsychiatry.2024.1870. Online ahead of print.

ABSTRACT

IMPORTANCE: Community-level social vulnerability (SV) is associated with physical illness and premature mortality. Its association with mental health (MH) and substance use disorders (SUDs) needs further study.

OBJECTIVE: To study associations of SV with clinical diagnoses of MH disorders, SUDs, and related treatments in the US noninstitutionalized population of adults aged 18 years and older.

DESIGN, SETTING, AND PARTICIPANTS: A survey of adults in a national sample of US households between October 2020 and October 2022. Participants drawn from a multistage, clustered, and stratified area probability sample of US households were included, excluding adults older than 65 years because of the difficulty of differentiating mental disorders from symptoms of dementia. The sample also included adults living in prisons, state psychiatric hospitals, and homeless shelters who were excluded from the sample of US households used in these analyses. Each sample household was sent a letter explaining the study and offering the option to complete the household roster online, by phone, or by email. Of the 12 906 adults selected for clinical interviewing in the household sample, 4674 completed clinical interviews.

MAIN OUTCOMES AND MEASURES: Main outcomes were Structured Clinical Interview for DSM-5 past-year diagnoses of MH disorders and SUDs and responses to survey questions regarding treatment received. The Social Vulnerability Metric (SVM) and the Area Deprivation Index (ADI) were used to determine SV at the residential zip code level.

RESULTS: The analysis involved 4674 participants (2904 [62.13%] female and 1770 [37.87%] male; mean [SD] age, 41.51 [13.41] years). Controlling for measured confounders, the SVM was significantly associated with diagnoses of schizophrenia spectrum disorder (SSD; adjusted odds ratio [aOR], 17.22; 95% CI, 3.05-97.29), opioid use disorder (OUD; aOR, 9.47; 95% CI, 2.30-39.02), stimulant use disorder (aOR, 6.60; 95% CI, 2.01-21.67), bipolar I disorder (aOR, 2.39; 95% CI, 1.19-4.80), posttraumatic stress disorder (aOR, 1.63; 95% CI, 1.06-2.50), and any MH disorder (aOR, 1.44; 95% CI, 1.14-1.83), but not major depressive disorder (MDD), generalized anxiety disorder (GAD), or any SUD. Results were similar for the ADI but generally of lower magnitude (SSD aOR, 11.38; 95% CI, 1.61-80.58; OUD aOR, 2.05; 95% CI, 0.30-14.10; stimulant use disorder aOR, 2.18; 95% CI, 0.52-9.18). Among participants with SSDs, SV was associated with reduced MH treatment (aOR, 0.001; 95% CI, 0.00-0.18) and reduced SUD treatment in participants with OUD or stimulant use disorder (aOR, 0.24; 95% CI, 0.02-2.80).

CONCLUSIONS AND RELEVANCE: In contrast to previous studies using nonclinical symptom-based survey data, we found no association between SV and GAD or MDD. By contrast, there were associations of SV with prevalence of SSD, stimulant use disorder, and OUD with corresponding decreases in treatment. These results suggest that the SVM might assist in developing more comprehensive care models that integrate medical and social care for MH disorders and SUDs.

PMID:39046728 | DOI:10.1001/jamapsychiatry.2024.1870

Curr Med Res Opin. 2024 Jul 24:1-17. doi: 10.1080/03007995.2024.2384589. Online ahead of print.

ABSTRACT

OBJECTIVE: Quality of bowel preparation and patient compliance are among the most important indicators to assess the quality of colonoscopy. To investigate the independent factors associated with the quality of bowel preparation in subjects undergoing colonoscopy and its impact on compliance.

METHODS: A total of 329 patient records were collected and were divided into an adequate bowel preparation group (272 cases) and an inadequate bowel preparation group (57 cases), or a compliant group (260 cases) and a non-compliant group (69 cases), based on bowel preparation quality or compliance. The quality of bowel preparation is evaluated using the Boston Bowel Preparation Scale. The comfort level of subjects during bowel preparation is assessed using the Kolcaba General Comfort Questionnaire (GCQ). Subjects’ compliance was assessed according to a self-developed compliance questionnaire. Prediction analyses were conducted to identify factors associated with the quality of bowel preparation and compliance.

RESULTS: Age, bowel preparation duration, history of bowel inadequacy, and laxative dosage showed statistical differences between the adequate and inadequate bowel preparation groups (P < 0.05). Age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation quality. Correlation analysis showed that GCQ scores was significantly negatively correlated with age, bowel preparation duration, laxative dose, defecation frequency, and colonoscopy duration (r < 0, P < 0.05), and positively correlated with sleep duration (r > 0, P < 0.05). In addition, age, gender, bowel preparation duration, and laxative dosage showed statistical differences between the compliant and non-compliant groups (P < 0.05). Logistic regression analysis revealed that age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation compliance. Age and bowel preparation duration were independent influencing factors for bowel preparation adequacy and compliance.

CONCLUSIONS: Age, bowel preparation duration, and laxative dosage are independent influencing factors for bowel preparation adequacy and compliance among patients undergoing colonoscopy at the First Affiliated Hospital, School of Medicine, Zhejiang University. It is recommended that a one-day low-residue diet combined with a 2000 mL laxative dosage be used as the bowel preparation protocol for the general colonoscopy population.

PMID:39046704 | DOI:10.1080/03007995.2024.2384589

Int J Clin Pharm. 2024 Jul 24. doi: 10.1007/s11096-024-01783-1. Online ahead of print.

ABSTRACT

BACKGROUND: Mobile health clinics have been used to provide healthcare to underserved communities, especially during the COVID-19 pandemic. Student-led clinics, operated by undergraduate health students, offer valuable training while serving these populations.

AIM: This cross-sectional study investigated the demographic characteristics and services provided by a mobile health clinic run by undergraduate pharmacy students, assessing its potential to reach underserved communities.

METHOD: The mobile health clinic operated from October 2023 to April 2024, staffed by 36 fourth-year pharmacy students. Services included cardiovascular disease risk screening and lifestyle advice. Demographic and service data were collected using an electronic primary care system and analysed with descriptive statistics.

RESULTS: The clinic served 716 users, with a demographic breakdown of 53.2% female and 46.8% male, predominantly aged 31-60 years. Users were ethnically diverse. Services provided included blood pressure (91.3%), BMI (91.3%), and diabetes risk assessments (54.9%). Many users reported low risk for smoking and alcohol consumption, but varied levels of physical activity. Referrals were made for cardiovascular disease risk and lifestyle support.

CONCLUSION: The mobile health clinic effectively reached a diverse, underserved population, providing essential health services and facilitating student training. Further research is needed to evaluate the long-term impact and cost-effectiveness of such clinics, and the follow-up care for referred patients.

PMID:39046691 | DOI:10.1007/s11096-024-01783-1

Endocr Pathol. 2024 Jul 24. doi: 10.1007/s12022-024-09819-y. Online ahead of print.

ABSTRACT

Unlike somatotroph tumors, the data on correlates of tumor granulation patterns in functional TPIT lineage pituitary neuroendocrine tumors (corticotroph tumors) have been less uniformly documented in most clinical series. This study evaluated characteristics of 41 well-characterized functional corticotroph tumors consisting of 28 densely granulated corticotroph tumors (DGCTs) and 13 sparsely granulated corticotroph tumors (SGCTs) with respect to preoperative clinical and radiological findings, tumor proliferative activity (including mitotic count and Ki-67 labeling index), and postoperative early biochemical remission rates. The median (interquartile range (IQR)) tumor size was significantly larger in the SGCT group [16.00 (16.00) mm in SGCT vs 8.5 (9.75) mm in DGCT, p = 0.049]. T2-weighted signal intensity and T2 intensity (quantitative) did not yield statistical significance based on tumor granulation; however, the T2 intensity-to-white matter ratio was significantly higher in SGCTs (p = 0.049). The median (IQR) Ki-67 labeling index was 2.00% (IQR 1.00%) in the DGCT group and 4.00% (IQR 7.00%) in the SGCT group (p = 0.043). The mitotic count per 2 mm² was higher in the SGCT group (p = 0.001). In the multivariate analysis, the sparse granulation pattern (SGCT) remained an independent predictor of a lower probability of early biochemical remission irrespective of the tumor size and proliferative activity (p = 0.012). The current study further supports the impact of tumor granulation pattern as a biologic variable and warrants the detailed histological subtyping of functional corticotroph tumors as indicated in the WHO classification of pituitary neuroendocrine tumors. More importantly, the assessment of the quantitative T2 intensity-to-white matter ratio may serve as a preoperative radiological harbinger of SGCTs.

PMID:39046680 | DOI:10.1007/s12022-024-09819-y

Int Ophthalmol. 2024 Jul 24;44(1):335. doi: 10.1007/s10792-024-03245-z.

ABSTRACT

PURPOSE: This study evaluates the long-term adjunctive use of netarsudil ophthalmic solution 0.02% in lowering IOP in patients with refractory glaucoma.

METHODS: This retrospective chart review study was conducted at a tertiary care center. Patients who were prescribed add-on netarsudil therapy and on ≥ 3 topical glaucoma medications from 01/01/2018 to 08/31/2020 were reviewed. 47 patients (69 eyes) met the inclusion criteria. Baseline IOPs prior to the addition of netarsudil were compared to IOPs measured at 3-, 6-, and 12-month intervals. Any patients with inadequate follow-up or who had glaucoma surgery after netarsudil initiation were excluded.

RESULTS: Median baseline IOP (± SD) was 21 ± 5.8 mmHg (median of 2 visits prior to initiation of netarsudil). At 3-month follow-up, 64 eyes had a median IOP of 16 ± 6.7 mmHg (p < 0.01). At 6-month follow-up, 56 eyes had a median IOP of 18 ± 4.6 mmHg (p < 0.01). At 12-month follow-up, 44 eyes had a median IOP of 15 ± 6.8 mmHg (p < 0.01). At the conclusion of the study, 64% of eyes reached 1 year follow-up due to several reasons.

CONCLUSIONS: Patients with refractory glaucoma showed statistically and clinically significant IOP reductions on netarsudil. IOP reduction was stable long-term with the largest decrease in IOP seen at 12 months. Although some patients will still go on to require further laser or incisional surgery, for most patients netarsudil is an effective treatment for adjunctive use in refractory glaucoma.

PMID:39046674 | DOI:10.1007/s10792-024-03245-z

Environ Monit Assess. 2024 Jul 24;196(8):758. doi: 10.1007/s10661-024-12901-x.

ABSTRACT

Spanning across Bangladesh and India, the Sundarban Delta consists of over a thousand islands, the majority of which are protected. These islands are important for the rich biodiversity and unique species found here. However, these islands are also at the forefront of climate change due to the impact of rising sea levels and extreme weather events. Therefore, we analyzed the long-term transformations in the land use land cover (LULC) between 1999 and 2020. We used a variety of geostatistical methods, including optimized hot spots cold spots and join count statistics, to examine the spatial patterns of changes in LULC across the study area. The results of our analysis revealed substantial changes in the spatial patterns of mangroves and pond aquaculture. The changes revealed a distinct north-south demarcation in spatial patterns, in the form of clustering of mangroves in the uninhabited islands located in the south and pond aquaculture clustered in the northern inhabited islands. The loss of area under mangroves was concentrated in the southern edges of the islands, which were most exposed to erosion in the open ocean. Nevertheless, we observed an increase in the area under mangroves in some of the northern riverine islands (17 km²). In the case of pond aquaculture, it was mostly concentrated in inhabited islands in the north. Most of the expansions were concentrated in the Indian part of the delta (631 km²). It is noteworthy that because of effective conservation measures, there was very limited overlap between mangroves and pond aquaculture, denoting the conversion of agricultural land to pond aquaculture instead of mangroves. Thus, the results of our study revealed the importance of local level conservation policies and anthropogenic activities, such as deforestation and local level disturbance like over-extraction of water and pollution, on the changing patterns of LULC across this unique, fragile ecosystem. Future studies may incorporate a finer resolution time series of LULC changes over time and space to enable more detailed analysis.

PMID:39046650 | DOI:10.1007/s10661-024-12901-x

Neurosurg Rev. 2024 Jul 24;47(1):349. doi: 10.1007/s10143-024-02594-8.

ABSTRACT

Many studies revealed that the sphenoid sinus pneumatization (SSP) affects the protrusion/dehiscence of adjacent structures including optic canal (OC), foramen rotundum (FR), vidian canal (VC), and carotid canal (CC). Knowledge of this relationship bears vital importance to identify the safest surgical route during transsphenoidal procedures. Therefore, we aimed to determine the individualized prevalence of the protrusion/dehiscence of adjacent structures based on sagittal and coronal SSP (SSSP and CSSP) patterns. Computed tomography images of 300 patients were analysed to identify the SSSP and CSSP types, and the protrusion/dehiscence of adjacent structures was determined. The relationship between the variables was examined using statistical analysis in terms of age, gender, and laterality. The most prevalent SSSP type was postsellar (62.7%), followed by sellar (30%), presellar (6.6%), and conchal (0.7%). In 71.3% of patients, five types of CSSP were observed, with 23.6% and 21.7% exhibiting Type IV and V, respectively. Our results indicated that postsellar type, Type IV and V CSSP associated with the highest likelihood of protrusion/dehiscence of OC, FR, VC, and CC. Furthermore, no significant correlation was observed between these qualitative variables and gender, with the exception of the VC dehiscence, the protrusion of OC and CC. No notable differences were identified with respect to laterality. Also, the probability of having postsellar type, Type IV and V CSSP, as well as the protrusion of OC, VC, and CC, decreased with increasing age. Further detailed analysis of this association is required to predict the size of the surgical window and to prevent neurovascular injury.

PMID:39046640 | DOI:10.1007/s10143-024-02594-8

Environ Sci Pollut Res Int. 2024 Jul 24. doi: 10.1007/s11356-024-34404-5. Online ahead of print.

ABSTRACT

Hydrological simulation in karstic areas is a hard task due to the intrinsic intricacy of these environments and the common lack of data related to their geometry. Hydrological dynamics of karstic sites in Mediterranean semiarid regions are difficult to be modelled mathematically owing to the existence of short wet episodes and long dry periods. In this paper, the suitability of an open-source SWAT method was checked to estimate the comportment of a karstic catchment in a Mediterranean semiarid domain (southeast of Spain), which wet and dry periods were evaluated using box-whisker plots and self-developed wavelet test. A novel expression of the Nash-Sutcliffe index for arid areas (ANSE) was considered through the calibration and validation of SWAT. Both steps were completed with 20- and 10-year discharge records of stream (1996-2015 to calibrate the model as this period depicts minimum gaps and 1985-1995 to validate it). Further, SWAT assessments were made with records of groundwater discharge and relating SWAT outputs with the SIMPA method, the Spain’s national hydrological tool. These methods, along with recurrent neural network algorithms, were utilised to examine current and predicted water resources available to supply urban demands considering also groundwater abstractions from aquifers and the related exploitation index. According to the results, SWAT achieved a “very good” statistical performance (with ANSE of 0.96 and 0.78 in calibration and validation). Spatial distributions of the main hydrological processes, as surface runoff, evapotranspiration and aquifer recharge, were studied with SWAT and SIMPA obtaining similar results over the period with registers (1980-2016). During this period, the decreasing trend of rainfalls, characterised by short wet periods and long dry periods, has generated a progressive reduction of groundwater recharge. According to algorithms prediction (until 2050), this declining trend will continue reducing groundwater available to meet urban demands and increasing the exploitation index of aquifers. These results offer valuable information to authorities for assessing water accessibility and to provide water demands in karstic areas.

PMID:39046638 | DOI:10.1007/s11356-024-34404-5

Emerg Radiol. 2024 Jul 24. doi: 10.1007/s10140-024-02269-3. Online ahead of print.

ABSTRACT

BACKGROUND: Many radiology programs utilize a night-float system to mitigate the effects of fatigue, improve patient care, and provide faster report turnaround times. Prior studies have demonstrated an increase in discrepancy rates during night-float shifts.

OBJECTIVES: This study was performed to examine the effects of night-float shift work on radiology resident cognition. We hypothesized that there would be diminished cognitive function on testing following night-float shifts when compared to testing following day shifts.

METHODS: Diagnostic radiology residents in their second to fifth years of residency at a single institution were recruited to participate in this pilot study. Cognitive function was evaluated using the Lumosity Neurocognitive Performance Tests (NCPT), standardized performance tests that provide real-time, objective measurements of cognitive function. Study participants completed the NCPT in 5 sessions following 5 consecutive day shifts to evaluate their baseline cognitive function. The tests were re-administered at the end of consecutive night-float shifts to assess for any changes. Sleep was objectively monitored using actigraphy devices worn around the wrist during all study weeks. Descriptive and summary statistics were performed.

RESULTS: 23 prospectively recruited diagnostic radiology residents working night-float shifts took a mean 13.6 (± 5.1) neurocognitive performance tests during the study period. There was a statistically significant decline in 2 of the 6 cognitive tests administered, signifying a decrease in attention, speed, and complex reasoning ability. Night-float shifts were significantly longer than the day shifts and associated with a significantly higher study volume and cross-sectional study volume. Fitbit data demonstrated that there were no significant differences in level of activity while awake. However, participants slept significantly longer during day shifts.

CONCLUSIONS: A sample of 23 radiology residents working night-float shifts demonstrated declines in attention, speed, and complex reasoning ability following sequential administration of standardized neurocognitive performance tests. While the sample size is small, these findings demonstrate the potential deleterious effects of night-float shift work and provide evidence to support further inquiry into this phenomenon.

PMID:39046634 | DOI:10.1007/s10140-024-02269-3