Nevin Manimala

JAMA Netw Open. 2024 May 1;7(5):e2411322. doi: 10.1001/jamanetworkopen.2024.11322.

ABSTRACT

IMPORTANCE: Concerns about the mental health of youths going through gender identity transitions have received increased attention. There is a need for empirical evidence to understand how transitions in self-reported gender identity are associated with mental health.

OBJECTIVE: To examine whether and how often youths changed self-reported gender identities in a longitudinal sample of sexual and gender minority (SGM) youths, and whether trajectories of gender identity were associated with depressive symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 4 waves (every 9 months) of a longitudinal community-based study collected in 2 large cities in the US (1 in the Northeast and 1 in the Southwest) between November 2011 and June 2015. Eligible participants included youths who self-identified as SGM from community-based agencies and college groups for SGM youths. Data analysis occurred from September 2022 to June 2023.

EXPOSURE: Gender identity trajectories and gender identity variability.

MAIN OUTCOMES AND MEASURES: The Beck Depression Inventory for Youth (BDI-Y) assessed depressive symptoms. Gender identity variability was measured as the number of times participants’ gender identity changed. Hierarchical linear models investigated gender identity trajectories and whether gender identity variability was associated with depressive symptoms over time.

RESULTS: Among the 366 SGM youths included in the study (mean [SD] age, 18.61 [1.71] years; 181 [49.4%] assigned male at birth and 185 [50.6%] assigned female at birth), 4 gender identity trajectory groups were identified: (1) cisgender across all waves (274 participants ), (2) transgender or gender diverse (TGD) across all waves (32 participants), (3) initially cisgender but TGD by wave 4 (ie, cisgender to TGD [28 participants]), and (4) initially TGD but cisgender by wave 4 (ie, TGD to cisgender [32 participants]). One in 5 youths (18.3%) reported a different gender identity over a period of approximately 3.5 years; 28 youths varied gender identity more than twice. The cisgender to TGD group reported higher levels of depression compared with the cisgender group at baseline (Β = 4.66; SE = 2.10; P = .03), but there was no statistical difference once exposure to lesbian, gay, bisexual, and transgender violence was taken into account (Β = 3.31; SE = 2.36; P = .16). Gender identity variability was not associated with within-person change in depressive symptoms (Β = 0.23; SE = 0.74; P = .75) or the level of depressive symptoms (Β = 2.43; SE = 2.51; P = .33).

CONCLUSIONS: These findings suggest that gender identity can evolve among SGM youths across time and that changes in gender identity are not associated with changes in depressive symptoms. Further longitudinal work should explore gender identity variability and adolescent and adult health.

PMID:38776085 | DOI:10.1001/jamanetworkopen.2024.11322

JAMA Netw Open. 2024 May 1;7(5):e2412535. doi: 10.1001/jamanetworkopen.2024.12535.

ABSTRACT

IMPORTANCE: Reducing the pretrial detention population has been a cornerstone of movements to end mass incarceration. Across many US cities, there are ongoing public debates on policies that would end pretrial detention due to the inability to afford bail, with some raising concerns that doing so would increase community violence.

OBJECTIVE: To evaluate changes in firearm violence after New Jersey’s 2017 bail reform policy that eliminated financial barriers to avoiding pretrial detention.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study used synthetic control methods to examine changes in firearm mortality and combined fatal and nonfatal shootings in New Jersey (2014-2019). New Jersey was chosen because it was one of the first states to systematically implement cash bail reform. Outcomes in New Jersey were compared with a weighted combination of 36 states that did not implement any kind of reform to pretrial detention during the study period. Data were analyzed from April 2023 to March 2024.

EXPOSURE: Implementation of New Jersey’s cash bail reform law in 2017.

MAIN OUTCOMES AND MEASURES: Quarterly rates of fatal and nonfatal firearm assault injuries and firearm self-harm injuries per 100 000 people.

RESULTS: Although New Jersey’s pretrial detention population dramatically decreased under bail reform, the study did not find evidence of increases in overall firearm mortality (average treatment effect on the treated, -0.26 deaths per 100 000) or gun violence (average treatment effect on the treated, -0.24 deaths per 100 000), or within racialized groups during the postpolicy period.

CONCLUSIONS AND RELEVANCE: Incarceration and gun violence are major public health problems impacting racially and economically marginalized groups. Cash bail reform may be an important tool for reducing pretrial detention and advancing health equity without exacerbating community violence.

PMID:38776084 | DOI:10.1001/jamanetworkopen.2024.12535

JAMA Netw Open. 2024 May 1;7(5):e2412824. doi: 10.1001/jamanetworkopen.2024.12824.

ABSTRACT

IMPORTANCE: Vascular disease is a treatable contributor to dementia risk, but the role of specific markers remains unclear, making prevention strategies uncertain.

OBJECTIVE: To investigate the causal association between white matter hyperintensity (WMH) burden, clinical stroke, blood pressure (BP), and dementia risk, while accounting for potential epidemiologic biases.

DESIGN, SETTING, AND PARTICIPANTS: This study first examined the association of genetically determined WMH burden, stroke, and BP levels with Alzheimer disease (AD) in a 2-sample mendelian randomization (2SMR) framework. Second, using population-based studies (1979-2018) with prospective dementia surveillance, the genetic association of WMH, stroke, and BP with incident all-cause dementia was examined. Data analysis was performed from July 26, 2020, through July 24, 2022.

EXPOSURES: Genetically determined WMH burden and BP levels, as well as genetic liability to stroke derived from genome-wide association studies (GWASs) in European ancestry populations.

MAIN OUTCOMES AND MEASURES: The association of genetic instruments for WMH, stroke, and BP with dementia was studied using GWASs of AD (defined clinically and additionally meta-analyzed including both clinically diagnosed AD and AD defined based on parental history [AD-meta]) for 2SMR and incident all-cause dementia for longitudinal analyses.

RESULTS: In 2SMR (summary statistics-based) analyses using AD GWASs with up to 75 024 AD cases (mean [SD] age at AD onset, 75.5 [4.4] years; 56.9% women), larger WMH burden showed evidence for a causal association with increased risk of AD (odds ratio [OR], 1.43; 95% CI, 1.10-1.86; P = .007, per unit increase in WMH risk alleles) and AD-meta (OR, 1.19; 95% CI, 1.06-1.34; P = .008), after accounting for pulse pressure for the former. Blood pressure traits showed evidence for a protective association with AD, with evidence for confounding by shared genetic instruments. In the longitudinal (individual-level data) analyses involving 10 699 incident all-cause dementia cases (mean [SD] age at dementia diagnosis, 74.4 [9.1] years; 55.4% women), no significant association was observed between larger WMH burden and incident all-cause dementia (hazard ratio [HR], 1.02; 95% CI, 1.00-1.04; P = .07). Although all exposures were associated with mortality, with the strongest association observed for systolic BP (HR, 1.04; 95% CI, 1.03-1.06; P = 1.9 × 10-14), there was no evidence for selective survival bias during follow-up using illness-death models. In secondary analyses using polygenic scores, the association of genetic liability to stroke, but not genetically determined WMH, with dementia outcomes was attenuated after adjusting for interim stroke.

CONCLUSIONS: These findings suggest that WMH is a primary vascular factor associated with dementia risk, emphasizing its significance in preventive strategies for dementia. Future studies are warranted to examine whether this finding can be generalized to non-European populations.

PMID:38776079 | DOI:10.1001/jamanetworkopen.2024.12824

JAMA Surg. 2024 May 22. doi: 10.1001/jamasurg.2024.1206. Online ahead of print.

ABSTRACT

IMPORTANCE: The optimal surgical repair of vaginal vault prolapse after hysterectomy remains undetermined.

OBJECTIVE: To compare the efficacy and safety of 3 surgical approaches for vaginal vault prolapse after hysterectomy.

DESIGN, SETTING, AND PARTICIPANTS: This was a multisite, 3-arm, superiority and noninferiority randomized clinical trial. Outcomes were assessed biannually up to 60 months, until the last participant reached 36 months of follow-up. Settings included 9 clinical sites in the US National Institute of Child Health and Human Development (NICHD) Pelvic Floor Disorders Network. Between February 2016 and April 2019, women with symptomatic vaginal vault prolapse after hysterectomy who desired surgical correction were randomized. Data were analyzed from November 2022 to January 2023.

INTERVENTIONS: Mesh-augmented (either abdominally [sacrocolpopexy] or through a vaginal incision [transvaginal mesh]) vs transvaginal native tissue repair.

MAIN OUTCOMES AND MEASURES: The primary outcome was time until composite treatment failure (including retreatment for prolapse, prolapse beyond the hymen, or prolapse symptoms) evaluated with survival models. Secondary outcomes included patient-reported symptom-specific results, objective measures, and adverse events.

RESULTS: Of 376 randomized participants (mean [SD] age, 66.1 [8.7] years), 360 (96%) had surgery, and 296 (82%) completed follow-up. Adjusted 36-month failure incidence was 28% (95% CI, 20%-37%) for sacrocolpopexy, 29% (95% CI, 21%-38%) for transvaginal mesh, and 43% (95% CI, 35%-53%) for native tissue repair. Sacrocolpopexy was found to be superior to native tissue repair (adjusted hazard ratio [aHR], 0.57; 99% CI, 0.33-0.98; P = .01). Transvaginal mesh was not statistically superior to native tissue after adjustment for multiple comparisons (aHR, 0.60; 99% CI, 0.34-1.03; P = .02) but was noninferior to sacrocolpopexy (aHR, 1.05; 97% CI, 0-1.65; P = .01). All 3 surgeries resulted in sustained benefits in subjective outcomes. Mesh exposure rates were low (4 of 120 [3%] for sacrocolpopexy and 6 of 115 [5%] for transvaginal mesh) as were the rates of dyspareunia.

CONCLUSIONS AND RELEVANCE: Among participants undergoing apical repair for vaginal vault prolapse, sacrocolpopexy and transvaginal mesh resulted in similar composite failure rates at study completion; both had lower failure rates than native tissue repair, although only sacrocolpopexy met a statistically significant difference. Low rates of mesh complications and adverse events corroborated the overall safety of each approach.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02676973.

PMID:38776067 | DOI:10.1001/jamasurg.2024.1206

Exp Appl Acarol. 2024 May 22. doi: 10.1007/s10493-024-00925-4. Online ahead of print.

ABSTRACT

The objective was to quantify and analyze the diversity of mites associated with native and cultivated açaí palms crops, as well as their distribution in the dry and rainy seasons in the municipalities of Bragança and Augusto Corrêa, state of Pará. Rarefaction curves were generated for diversity values using the statistical programming language R, rarefaction curves for estimates of richness and equitability, and analysis of variance with permutations. A total of 2069 mites from 28 families were sampled, being most representative Phytoseiidae (32.4%), Phytoptidae (13%), Cunaxidae (7.7%), Tetranychidae (5.6%) and Tydeidae (4.9%). Among predators, the most abundant species were Amblyseius sp. 1, Armascirus amazoniensis Wurlitzer & Silva, Iphiseiodes zuluagai Denmark & Muma, Scutopalus tomentosus Rocha, Skvarla & Ferla, and the phytophagous mites Acaphyllisa sp., Davisella sp., Oligonychus sp. and Retracus johnstoni Keifer. In the rainy season, more mites were sampled (n = 1176) than in the dry season (n = 893). The greatest richness was observed in the dry period (73 species) and diversity was also greater in this period. In the municipality of Bragança there was greater richness (78 species) and the cultivated açaí trees had greater acarine abundance (74.7%) than the native ones. However, natives had slightly higher wealth (6%) than those cultivated. The diversity and richness of predatory mites show the potential of the Amazon biome to be used in applied biological control.

PMID:38776058 | DOI:10.1007/s10493-024-00925-4

Int Urol Nephrol. 2024 May 22. doi: 10.1007/s11255-024-04088-4. Online ahead of print.

ABSTRACT

OBJECTIVE: Prostate cancer is one of the most common malignant neoplasms in elderly males, with radical prostatectomy being the established therapeutic approach for localized disease. Patients undergoing this surgical procedure frequently experience increased negative emotions and symptomatology during the perioperative period, likely due to concerns about the illness and its treatment. The present study aims to investigate the effects of a novel educational approach involving a whole-process visualization and collaborative nursing discussions on perioperative symptoms and emotional well-being in radical prostatectomy patients.

METHODS: Data were prospectively collected from 310 patients admitted to the hospital between June 2021 and December 2023, all of whom were scheduled to undergo radical prostatectomy. These patients were randomly assigned to either the intervention group (receiving new model education) or the control group (receiving conventional education), with 155 patients in each group. The study compared basic demographic information, anxiety and depression scores, fear of disease progression scores, quality-of-life scores, main symptom scores, and changes in perioperative vital signs between the two groups.

RESULTS: No statistically significant differences were observed between the two groups in terms of age, comorbidities, insurance type, education level, income, and tumor history (P > 0.05). Similarly, there were no significant differences in anxiety and depression scores, proportion of patients with anxiety and depression, vital signs, and fear of disease progression scores between the two groups at Time 1 stage (P > 0.05). During stages Time 2 and Time 3, the intervention group exhibited lower anxiety and depression scores, a lower proportion of anxious and depressed patients, as well as significantly reduced blood pressure and heart rate fluctuations compared to the control group (P < 0.05). Following radical prostatectomy, the main symptoms of patients, such as pain, nausea, and fatigue, were assessed using the MADIS Symptom Assessment Scale on days 1-3 post-surgery. The intervention group exhibited significantly lower scores for three symptoms compared to the control group (P < 0.05); at Time 4 stage, the patients in the intervention group also demonstrated significantly improved quality-of-life scores compared to the control group (P < 0.05). Additionally, blood pressure and heart rate of patients returned to baseline levels at Time 4 stage, with no significant difference between the two groups (P > 0.05). Nevertheless, the anxiety and depression scores in the intervention group at the Time 4 stage remained significantly lower than those in the control group (P < 0.05). Additionally, the fear of disease progression scores in both groups were lower than those at the Time 1 stage, with a more pronounced improvement observed in the intervention group compared to the control group (P < 0.05).

CONCLUSION: Patients diagnosed with malignant tumors often experience fear and anxiety regarding the progression of their disease and upcoming surgery, as well as uncertainty surrounding their treatment and prognosis. This heightened emotional distress can contribute to a greater symptom burden during the perioperative period. Utilizing a whole-process visualization and collaborative nursing discussion approach, as compared to traditional communication methods, has been shown to alleviate patients’ fears, reduce anxiety and depression, and ultimately lessen the symptom burden experienced during the perioperative phase. Ultimately, this approach can enhance the overall quality of life for patients facing malignant tumors.

PMID:38776055 | DOI:10.1007/s11255-024-04088-4

Ultrasound Obstet Gynecol. 2024 May 22. doi: 10.1002/uog.27705. Online ahead of print.

ABSTRACT

OBJECTIVE: To establish a normal reference interval for amniotic sac measurements between 7 and 10 weeks of gestation and its relative size in relation to the gestational sac and the embryo.

METHOD: This was a prospective, cross-sectional study of consecutive women presenting to UCLH Early Pregnancy Unit between August 2022 to June 2023. We included live, normally sited, singleton pregnancies with a normal 20-week anomaly scan. We collected 120 cases per gestational week totaling 360 cases. We performed an inter and intra-observer variability assessment in the measurement of mean ASD in 30 patients. Regression analyses were used to establish reference intervals for GSD to CRL, ASD to CRL, GSD to ASD and GSD:ASD ratio to CRL. The fitted regression line was calculated, along with a 90% prediction interval and the R² value.

RESULTS: There was good interobserver agreement (difference 0.007mm ± 1.105 (95%CI -2.160 to 2.174)) and good intra-observer agreement between Observer A (0.007 ± 1.105 (-2.160 to 2.174)) and Observer B (-0.014 ± 0.919 (-1.814 to 1.786)) in the measurement of mean ASD in 30 patients. Regression analyses showed a highly statistically significant association between each pair of values (all p-values <0.001). There were significant quadratic associations between mean GSD and CRL (R² = 56%) and mean GSD and ASD (R² = 60), significant cubic association between ASD and CRL (R² = 90%) and significant quadratic association between GSD to ASD ratio and CRL (R² = 68%). The regression equations were used to quantify the values of ASD and GSD to ASD ratios for a range of CRL values and gestational age in days.

CONCLUSION: Our study has produced comprehensive reference intervals for amniotic sac size in early pregnancy which could be used in routine clinical practice. This article is protected by copyright. All rights reserved.

PMID:38776053 | DOI:10.1002/uog.27705

Clin Exp Med. 2024 May 22;24(1):107. doi: 10.1007/s10238-024-01371-7.

ABSTRACT

Predicting the likelihood vascular events in patients with BCR/ABL1-negative myeloproliferative neoplasms (MPN) is essential for the treatment of the disease. However, effective assessment methods are lacking. Thrombin-antithrombin complex (TAT), plasmin-α₂– plasmininhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) are the new direct indicators for coagulation and fibrinolysis. The aim of this study was to investigate the changes of these four new indicators in thrombotic and hemorrhagic events in BCR/ABL1-negative MPN. The study cohort of 74 patients with BCR/ABL negative myeloproliferative disorders included essential thrombocythemia, polycythemia vera, and primary myelofibrosis (PMF). A panel of 4 biomarkers, including TAT, PIC, TM, and t-PAIC were determined using Sysmex HISCL5000 automated analyzers, whereas fibrin/fibrinogen degradation products (FDP), D-dimer and Antithrombin III (ATIII) were analyzed using Sysmex CS5100 coagulation analyzer. A total of 24 (32.4%) patients experienced thrombotic events and hemorrhagic events occurred in 8 patients (10.8%). Compared to patients without hemorrhagic-thrombotic events, patients with thrombotic events had higher fibrinogen (FIB) level, FDP level and lower ATIII activity, while patients with hemorrhagic events had lower white blood cell count and hemoglobin level, higher FDP level (P < 0.05). Patients with a JAK2V617F mutation were more likely to experience thrombotic events (P < 0.05). In addtion, patients with thrombotic events had higher TAT, PIC, TM, and t-PAIC levels than patients without hemorrhagic-thrombotic events (P < 0.05), whereas patients with hemorrhagic events had a lower median value in TAT and TM (no statistical difference, P > 0.05). Patients with higher TAT, TM and t-PAIC were more likely to experience thrombotic events (P < 0.05), and only TAT was positively correlated with thrombotic events (Spearman r =0.287, P = 0.019). TAT, PIC, TM, and t-PAIC combined with ATIII and FDP have a certain value for predicting thrombosis in patients with BCR/ABL1-negative MPN. These 6 parameters are worth further exploration as predictive factors and prognostic markers for early thrombotic events.

PMID:38776019 | DOI:10.1007/s10238-024-01371-7

Arch Dermatol Res. 2024 May 22;316(5):192. doi: 10.1007/s00403-024-02924-2.

ABSTRACT

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time.

METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered.

RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036.

CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

PMID:38775980 | DOI:10.1007/s00403-024-02924-2

Arch Dermatol Res. 2024 May 22;316(5):187. doi: 10.1007/s00403-024-02963-9.

ABSTRACT

Inadequate education regarding disease manifestations in diverse skin colors hinders diagnosis and exacerbates health disparities. All levels of medical trainees report low confidence in accurately identifying disease in skin of color (SOC). To help further elucidate these concerns, our research aims to assess medical student confidence in recognizing cutaneous diseases in SOC and their viewpoints regarding SOC education within their institution. An eight-question, open-ended survey was provided to medical students before and after a SOC presentation. The survey assessed participants’ confidence in their diagnostic ability and perspectives on educational material. Among the 70 attendees, 58 (82.8%) and 64 (91.4%) completed the pre- and post-seminar surveys, respectively. There was a significant discrepancy in confidence levels when assessing cutaneous manifestations of internal pathology in light (Monk Skin Colors 1-5) versus dark (Monk Skin Colors 6-10) skin (p < 0.009). Notably, 78.7% (37/47) perceived the institutional learning materials as insufficient for SOC. Post-seminar reflections indicated that 87.2% (40/46) of students lacked confidence in diagnosing SOC, with 78.7% (32/46) citing inadequate curriculum coverage as the cause. An additional 8.5% (6/46) identified the predominance of white-centric medical descriptions as a hindrance. Students collectively called for improved educational approaches, including better visual representation of diseases in darker skin. Medical education must continue to strive for increased SOC representation to train competent physicians in treating a diverse patient population and reduce disparities in SOC patients.

PMID:38775979 | DOI:10.1007/s00403-024-02963-9