Nevin Manimala

JAMA Netw Open. 2024 Oct 1;7(10):e2440997. doi: 10.1001/jamanetworkopen.2024.40997.

ABSTRACT

IMPORTANCE: Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants.

OBJECTIVE: To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study examined US pediatric ICU encounters with and without RSV from January 1, 2017, to June 1, 2023. Data were from Oracle Cerner RealWorld Data, a national electronic health record database. All children (aged >1 day and <18 years) admitted to an ICU during the study period were included in the analysis. Statistical analysis was performed from February to May 2024.

MAIN OUTCOMES AND MEASURES: The primary outcomes were ICU encounters with RSV and ICU encounters with RSV eligible for RSV prevention.

RESULTS: There were 119 782 ICU encounters from 53 hospitals; 65 757 encounters (54.9%) were male; median (IQR) age was 4.5 (1.1-12.5) years, median (IQR) ICU length of stay was 1.8 (1.0-3.9) days; 13 702 ICU encounters (11.4%) had RSV, of which 38.6% (5217) were eligible for prevention (4.4% of total ICU encounters). Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days). Encounters with RSV were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; P < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; P < .001) compared with those without RSV.

CONCLUSIONS AND RELEVANCE: The findings of this retrospective cross-sectional study of RSV and US pediatric intensive care utilization suggest that if 65% to 85% of eligible children received RSV prevention, an estimated 2.1% to 2.8% reduction in pediatric ICU encounters and an estimated 4.5% to 5.9% reduction in pediatric ICU days could be achieved.

PMID:39453655 | DOI:10.1001/jamanetworkopen.2024.40997

JAMA Netw Open. 2024 Oct 1;7(10):e2441372. doi: 10.1001/jamanetworkopen.2024.41372.

ABSTRACT

IMPORTANCE: Results of clinical trials can only represent included participants, and many neonatal trials fail due to insufficient participation. Infants not included in research may differ from those included in meaningful ways, biasing the sample and limiting the generalizability of findings.

OBJECTIVE: To describe the proportion of eligible infants included in neonatal clinical trials and the reasons for noninclusion.

EVIDENCE REVIEW: A systematic search of Cochrane CENTRAL was performed by retrieving articles meeting the following inclusion criteria: full-length, peer-reviewed articles describing clinical trial results in at least 20 human infants from US neonatal intensive care units, published in English, and added to Cochrane CENTRAL between 2017 and 2022. Retrieved articles were screened for inclusion by 2 independent researchers.

FINDINGS: In total 120 articles met inclusion criteria and 91 of these (75.8%) reported the number of infants eligible for participation, which totaled 26 854 in aggregate. Drawing from these, an aggregate of 11 924 eligible infants (44.4%) were included in reported results. Among all eligible infants, most reasons for noninclusion in results were classified as modifiable or potentially modifiable by the research team. Parents declining to participate (8004 infants [29.8%]) or never being approached (2507 infants [9.3%]) were the 2 predominant reasons for noninclusion. Other modifiable reasons included factors related to study logistics, such as failure to appropriately collect data on enrolled infants (859 of 26 854 infants [3.2%]) and other reasons (1907 of 26 854 infants [7.1%]), such as loss to follow-up or eligible participants that were unaccounted for. Nonmodifiable reasons, including clinical change or death, accounted for a small proportion of eligible infants who were not included (858 of 26 854 infants [3.2%]).

CONCLUSIONS AND RELEVANCE: This systematic review of reporting on eligible infants included and not included in neonatal clinical trials highlights the need for improved documentation on the flow of eligible infants through neonatal clinical trials and may also inform recruitment expectations for trialists designing future protocols. Improved adherence to standardized reporting may clarify which potential participants are being missed, improving understanding of the generalizability of research findings. Furthermore, these findings suggest that future work to understand why parents decline to participate in neonatal research trials and why some are never approached about research may help increase overall participation.

PMID:39453652 | DOI:10.1001/jamanetworkopen.2024.41372

JAMA Netw Open. 2024 Oct 1;7(10):e2441499. doi: 10.1001/jamanetworkopen.2024.41499.

ABSTRACT

IMPORTANCE: Youth, parents, educators, and policymakers are concerned about the potential relationship between social media use and negative mental health outcomes, including risk for suicidal thoughts and behaviors.

OBSERVATIONS: Current research shows complex and conflicting relationships between social media use and suicide risk. A key limiting factor in clarifying these relationships is a dearth of available information on contextual factors around social media use, with most research focusing only on hours or amount of engagement. Whereas there are clear associations between some types of social media use and suicide risk, there are also many opportunities to mitigate suicide risk through social media. Several methodologic and measurement issues make research challenging. Researchers have only begun to explore how specific risk factors interact with individual vulnerabilities, how social media can be used to enhance youth well-being, and whether and under what circumstances mitigation strategies can be helpful.

CONCLUSIONS AND RELEVANCE: This overview identifies research gaps and methodological challenges that need to be addressed to guide intervention strategies and future policy relevant to youth and suicide risk.

PMID:39453651 | DOI:10.1001/jamanetworkopen.2024.41499

Technol Health Care. 2024 Sep 5. doi: 10.3233/THC-240602. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of posterior malleolus fractures in ankle fractures ranges from 7% to 44%. Studies have indicated a poorer prognosis for ankle joint function when a posterior malleolar fracture is present, underscoring the significance of active intervention for optimal postoperative ankle function recovery. Hence, the selection of treatment for such fractures holds particular importance.

OBJECTIVE: Screw fixation is a key treatment for posterior malleolus fractures (PMFs) or Haraguchi Type 1 fractures involving less than 25% of the distal tibia’s articular surface. However, the optimal screw placement direction – anteroposterior (AP) or posterior-anterior (PA) – remains debated. This meta-analysis aims to compare these two approaches for treating posterior ankle fractures, focusing on the efficacy of PA fixation.

METHODS: We searched the Cochrane Library, EMBASE, PubMed, SinoMed, and Web of Science databases from their inception to October 20, 2022. Methodological quality was assessed using the Cochrane Collaboration’s tool for assessing bias risk in randomized controlled trials (RCTs). Stata MP17 software was used to compare the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, full weight-bearing time, and fracture healing time at the last follow-up between the two fixation methods.

RESULTS: A total of 403 patients with posterior malleolar fractures from six RCTs met the inclusion criteria. The meta-analysis revealed a higher AOFAS score at the last follow-up for PA placement compared to AP placement [SMD = 0.512, 95% CI (0.244 to 0.780), z= 3.74, P< 0.001]. Postoperative full weight-bearing time and fracture healing time did not show statistically significant differences between the two groups.

CONCLUSION: PA fixation demonstrated a superior AOFAS score compared to AP fixation for posterior malleolar fractures. PA screw placement offers advantages in restoring ankle joint stability and enhancing joint function recovery post-surgery.

PMID:39453647 | DOI:10.3233/THC-240602

Hum Antibodies. 2024 Sep 23. doi: 10.3233/HAB-240036. Online ahead of print.

ABSTRACT

BACKGROUND: The autoimmune disorder known as Graves’ disease. The condition is due to the binding of thyroid-stimulating immunoglobulins to the thyrotropin receptor located on the thyroid gland. The result is an excess of thyroidal hormones. symptoms of hyperthyroidism, and the formation of diffuse goiter.

OBJECTIVES: This research intends to quantify the levels of CD40L, TSAB in people who suffer from Graves’ disease. It also aims to determine the relationship between TSAB and the duration of the disease, as well as analyze the role of CD40L as a predictive marker for Graves’ disease using medcalc Statistical Software version 16.4.3 and SAS (2018).

METHODS: In a case-control study, randomly selected 90 graves disease patients were included, the randomly selected patients were divided equally and matched into a case group who have graves disease and graves disease-free patients as a control group. For both groups whole blood sample was examined to compare for (TSAB), and (CD40L) levels determination by ELISA technique.

RESULTS: The average serum levels of CD40L showed a highly significant correlation (P value < 0.01) among the groups examined for Graves’ disease. The patient group consisted of 13 males (28.89%) and 32 females (71.11%). No significant correlation was identified between TSAB and the duration of the condition.

CONCLUSION: Thyroid stimulating antibody (TSAb) test and ultrasonography of the thyroid gland are valuable diagnostic techniques for autoimmune Graves’ disease (GD). CD40L could potentially serve as a predictive diagnostic marker for Graves’ disease. However, there is no observed link between the duration of the disease and the concentration of TSAB.

PMID:39453646 | DOI:10.3233/HAB-240036

JAMA Health Forum. 2024 Oct 4;5(10):e243669. doi: 10.1001/jamahealthforum.2024.3669.

ABSTRACT

IMPORTANCE: Research suggests the social, physical, and socioeconomic contexts of residing in segregated neighborhoods may negatively affect mental health.

OBJECTIVE: To assess the association between racial residential segregation and prenatal mental health among Asian, Black, Hispanic, and White individuals.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study was conducted in Kaiser Permanente Northern California (KPNC), an integrated health care delivery system. Participants included self-identified Asian, Black, Hispanic, and White pregnant individuals who attended at least 1 prenatal care visit at KPNC between January 1, 2014, and December 31, 2019. Data were analyzed from January 14, 2023, to August 15, 2024.

EXPOSURES: Racial residential segregation, defined by the local Getis-Ord Gi* statistic, was calculated in each racial and ethnic group and categorized as low (<0), medium (0-1.96), or high (>1.96). A positive Gi* statistic indicates overrepresentation (greater clustering or segregation) of the racial and ethnic group in an index census tract and neighboring tracts compared with the larger surrounding geographic area.

MAIN OUTCOMES AND MEASURES: Prenatal depression and anxiety defined by diagnoses codes documented in the electronic health record between the first day of the last menstrual period and the day prior to birth.

RESULTS: Among the 201 115 participants included in the analysis (mean [SD] age, 30.8 [5.3] years; 26.8% Asian, 6.6% Black, 28.0% Hispanic, and 38.6% White), prenatal depression and anxiety were highest in Black individuals (18.3% and 18.4%, respectively), followed by White (16.0% and 18.2%, respectively), Hispanic (13.0% and 14.4%, respectively), and Asian (5.7% and 6.4%, respectively) individuals. Asian (40.8% vs 31.1%) and Black (43.3% vs 22.6%) individuals were more likely to live in neighborhoods with high vs low segregation, while Hispanic individuals were equally likely (34.3% vs 34.7%). High compared with low segregation was associated with greater odds of prenatal depression (adjusted odds ratio [AOR], 1.25 [95% CI, 1.10-1.42]) and anxiety (AOR, 1.14 [95% CI, 1.00-1.29]) among Black individuals. High segregation was associated with lower odds of prenatal depression among Asian (AOR, 0.75 [95% CI, 0.69-0.82]), Hispanic (AOR, 0.88 [95% CI, 0.82-0.94]), and White (AOR, 0.91 [95% CI, 0.86-0.96]) individuals. Similar associations were found for anxiety among Asian (AOR, 0.80 [95% CI, 0.73-0.87]) and Hispanic (AOR, 0.88 [95% CI, 0.82-0.93]) but not White (AOR, 0.95 [95% CI, 0.90-1.00]) individuals.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, racial and ethnic residential segregation was associated with worse prenatal mental health for Black individuals but better mental health for Asian, Hispanic, and White individuals. Policies reducing segregation and its impact may improve mental health outcomes in pregnant Black individuals.

PMID:39453637 | DOI:10.1001/jamahealthforum.2024.3669

Sleep. 2024 Oct 25:zsae252. doi: 10.1093/sleep/zsae252. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: The umbrella term “Disorders of Arousal” (DoA), encompassing sleepwalking, confusional arousals, and sleep terrors, refers to parasomnias manifesting during non-rapid eye movement (NREM) sleep, commonly thought to arise from an aberrant arousal process. While previous studies have detailed EEG changes linked to DoA episodes, it remains uncertain how these alterations differ from a physiological arousal process. This study directly compared brain activity between DoA episodes and arousals associated with physiological movements (motor arousal) in individuals with DoA and healthy sleepers.

METHODS: Fifty-three adult patients with DoA (25 males, 32.2±15.5years) and 33 control subjects (14 males, 31.4±11.4years) underwent one or more home-EEG recordings. A semiparametric regression model was employed to elucidate the complex relationship between EEG activity across channels, within and across different groups, including motor arousals in DoA (n=169), parasomnia episodes in DoA (n=361), and motor arousals in healthy sleepers (n=137).

RESULTS: Parasomnia episodes and motor arousals in both groups were preceded by a diffuse increase in slow-wave activity (SWA) and beta power, and a widespread decrease in sigma power. However, motor arousals in DoA displayed lower beta and central sigma than in healthy sleepers. Within DoA patients, episodes were preceded by lower beta, frontal sigma, and higher SWA than motor arousals.

CONCLUSIONS: Our findings suggest that the arousal process is altered in DOA patients, and that specific EEG patterns are required for DOA episodes to emerge. These insights will help guide future research into the underlying circuits and objective markers of DOA.

PMID:39453616 | DOI:10.1093/sleep/zsae252

J Racial Ethn Health Disparities. 2024 Oct 25. doi: 10.1007/s40615-024-02197-5. Online ahead of print.

ABSTRACT

BACKGROUND: While the National Institutes of Health emphasize integrating sex as a biological variable into research, specific considerations of sex-related differences in pulmonary embolism (PE) mortality trends remain scarce. This study examines sex-based PE mortality trends across regional and demographic groups in the USA from 1999 to 2020.

METHODS: A retrospective analysis of National Center for Health Statistics mortality data from 1999 to 2020 was conducted. Using ICD-10 code I26, PE decedents were identified. Piecewise linear regression assessed sex-based temporal trends in PE mortality by age, race/ethnicity, and census region. Annual percentage changes and average annual percentage changes were derived using Weighted Bayesian Information Criteria. The 95% confidence intervals were estimated using the empirical quantile method.

RESULTS: From 1999 to 2020, a total of 179,273 individuals died in the USA due to PE, resulting in an age-adjusted mortality rate of 2.5 per 100,000 persons (95% CI, 2.5-2.5). While men and women exhibited comparable rates in recent time segments and across most subcategories, a higher mortality trend among males compared to females was observed among non-Hispanic White and Hispanic individuals and residents of the Western US census region. These results remained robust even after excluding data from 2020, accounting for the potential impact of the COVID-19 pandemic.

CONCLUSIONS: Our study highlights sex-based disparities in PE mortality trends in the USA from 1999 to 2020. Despite overall stable mortality rates, higher trends among males were evident in specific demographic groups and regions. These findings emphasize the importance of targeted interventions to mitigate PE-related mortality discrepancies across diverse populations.

PMID:39453605 | DOI:10.1007/s40615-024-02197-5

Dermatol Ther (Heidelb). 2024 Oct 25. doi: 10.1007/s13555-024-01293-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite advancements in the treatment of psoriasis (PsO), there are few head-to-head studies assessing comparative effectiveness of the newest therapies approved to treat PsO. Our objective was to assess the comparative clinical effectiveness of risankizumab and deucravacitinib in patients with moderate-to-severe PsO.

METHODS: This placebo-anchored matching-adjusted indirect comparison (MAIC) analysis utilized data from UltIMMa-1/2 risankizumab and POETYK PSO-1/2 deucravacitinib trials. Individual patient data from UltiMMA-1/2 were weighted via propensity score to match POETYK PSO-1/2 published summary data. Rate differences between risankizumab and deucravacitinib were assessed for Psoriasis Area and Severity Index (PASI) 75/90/100, the Static Physician Global Assessment (sPGA = 0 or 0/1), and the Dermatology Life Quality Index (DLQI) 0/1.

RESULTS: At 16 weeks, risankizumab-treated patients demonstrated statistically significantly higher rates of skin clearance and greater improvement in quality of life (QoL) compared to those treated with deucravacitinib. Across all outcomes, risankizumab demonstrated a lower number needed to treat compared to deucravacitinib. Limitations are potential bias due to unobserved/unmeasurable differences and limited generalizability of the results.

CONCLUSIONS: This indirect comparison demonstrates that risankizumab has higher rates of skin clearance and greater improvements in QoL than deucravacitinib. This study will help inform healthcare providers in their treatment and management strategy of PsO.

PMID:39453596 | DOI:10.1007/s13555-024-01293-y

Environ Monit Assess. 2024 Oct 25;196(11):1104. doi: 10.1007/s10661-024-13261-2.

ABSTRACT

Due to the continued increase in land use changes and changing climatic patterns in the Lake Victoria basin, understanding the impacts of these changes on the water quality of Lake Victoria is imperative for safeguarding the integrity of the freshwater ecosystem. Thus, we analyzed spatial and temporal patterns of land cover, precipitation, and water quality changes in the Lake Victoria basin between 2000 and 2022 using global satellite products. Focusing on chlorophyll-a (Chl-a) and turbidity (TUR) in Lake Victoria, we used statistical metrics (correlation coefficient, trend analysis, change budget, and intensity analysis) to understand the relationship between land use and precipitation changes in the basin with changes in Chl-a and TUR at two major pollution hotspots on the lake, i.e., Winam Gulf and Inner Murchison Bay (IMB). Results show that the Chl-a and TUR concentrations in the Winam gulf increase with increases in precipitation. Through increases in precipitation, the erosion risks are increased and transport of nutrients from land to the lake system, promoting algal growth and turbidity. In the IMB, Chl-a and TUR concentrations decrease with an increase in precipitation, possibly due to dilution, but peak during moderate rainfall. Interestingly, changes in land use and land cover (LULC) at 5-year intervals showed no substantial correlation with water quality changes at selected hotspots even though a broader LULC change analysis over the past two decades indicated a notable 300% increase in built-up areas across the Lake Victoria basin. These findings underscore the dominant influence of precipitation changes over LULC changes on the water quality of Lake Victoria for the selected hotspot areas.

PMID:39453572 | DOI:10.1007/s10661-024-13261-2