Nevin Manimala

J Pediatr Endocrinol Metab. 2022 Oct 26. doi: 10.1515/jpem-2022-0305. Online ahead of print.

ABSTRACT

OBJECTIVES: Use of complementary and alternative medicine (CAM) is widespread. This study aimed to investigate the use of CAM in children with central precocious puberty (PP) who used gonadotropin-releasing hormone analog (GnRHa) treatment.

METHODS: Parents of 108 patients who were diagnosed as having PP were involved in the study. A questionnaire was administered to the parents during follow-ups. The patients were divided into two groups according to the use of CAM.

RESULTS: Forty (37%) patients had used CAM. Parents who graduated from primary school tended not to use CAM (χ ² =10.463; p=0.015). There was no other statistically significant difference between the sociodemographic features (p>0.05). The most common information source was physicians (40%). Seventy-five percentage of CAM users and 44.1% of non-CAM users knew/heard about herbal medicine (χ ² =8.517; p=0.004) and herbal medicine was the most common type of CAM used. 80% of parents in the CAM group and 54.4% of parents in the non-CAM group knew at least one biologically based therapy that had estrogenic activity (χ ² =6.082; p=0.014). Seventy-one percentage of parents in the CAM group and 29% of parents in the non-CAM group stated that they would consider using CAM in the future (χ ²=16.979; p<0.001).

CONCLUSIONS: The use of CAM among patients with PP is high. Although most CAM therapies are harmless, there may be adverse effects or drug interactions with current conventional treatment in children. Health professionals should be aware and inquire about the use and type of CAM, considering the medical history at every patient encounter.

PMID:36288430 | DOI:10.1515/jpem-2022-0305

Vestn Oftalmol. 2022;138(5):39-46. doi: 10.17116/oftalma202213805139.

ABSTRACT

Intrastromal keratoplasty has recently been widely used in the surgical treatment of keratoconus (KC). In 2013, a new type of interlamellar keratoplasty operation was developed – bandage therapeutic-optical keratoplasty (BTOK).

PURPOSE: Evaluation of the long-term outcomes of surgical treatment of stages II and III progressive KC with BTOK technique.

MATERIAL AND METHODS: The study included 107 patients (126 eyes): group 1 with stage II KC – 78 eyes, 100% of these patients were observed for 1 year, 52 eyes (66%) for 3 years, and 18 eyes (23%) for 5 years; group 2 – 48 eyes with stage III KC, with 100% of them observed for 1 year, 39 eyes (81%) for 3 years, and 12 eyes (25%) – 5 years. All patients received a customized allograft in the form of an intrastromal corneal ring segment (ICRS).

RESULTS: During the first year after BTOK surgery, the uncorrected and corrected visual acuity (UCVA and CVA) in the first group increased by 0.5±0.04 (p<0.05) and 0.2±0.02 (p<0.05), respectively, in the second group – by 0.46±0.05 (p<0.05) and 0.47±0.05 (p<0.05) due to a decrease in refractive indices in the central 3.0 mm zone. In the first group, mean refraction in the central 3.0 mm zone (K_m) was within 45±3.75 (p<0.05), in the second – 48.63±.2 diopters (p<0.05), while maximum refraction in the central 3.0 mm zone (K_max) decreased from 50.02±2.20 (p<0.05) to 44.61±1.03 diopters (p<0.05) in the first group, from 58.21±3.43 (p<0.05) to 50.45±3.46 diopters (p<0.05) in the second group. The values of UCVA, CVA and refractive indices of the central corneal zone in the first and second groups did not change statistically significantly after three and five years. Minimum corneal thickness in the first group increased from 476.23±13.35 to 485.08±15.80 µm (p<0.05), in the second – from 412.73±38.63 to 422.00±42.25 µm (p<0.05).

CONCLUSION: BTOK surgery can be used in patients with stages II and III KC to improve the visual functions, strengthen the ectatic cornea and stop the progression of the disease.

PMID:36288416 | DOI:10.17116/oftalma202213805139

Vestn Oftalmol. 2022;138(5):30-38. doi: 10.17116/oftalma202213805130.

ABSTRACT

In recent years, a new class of extended depth of focus (EDOF) intraocular lenses (IOLs) has become available on the market. There is only a limited number of scientific papers comparing trifocal and EDOF IOL data, and the results are often contradictory.

PURPOSE: Comparative analysis of the results of trifocal and EDOF IOL implantation in patients with presbyopia and/or cataract.

MATERIAL AND METHODS: This prospective study included 72 patients (144 eyes) after bilateral implantation of either Tecnis Symfony EDOF IOL (18 patients, 36 eyes; group I) or AcrySof PanOptix trifocal IOL (54 patients, 108 eyes; group II). In 18 patients out of 72 (25%) the implantation involved mini-monovision, i.e. the calculation of the IOL power on the nondominant eye was performed at -0.5 D. The average follow-up period for the patients was 7.1±1.2 months.

RESULTS: There was a significant (p<0.05) increase in uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA) and uncorrected distance visual acuity (UCDVA) at the maximum follow-up time compared to the preoperative indices in all groups. Group II was characterized by slightly better UCNVA dynamics (0.85±0.13 versus 0.2±0.04 before surgery, as comparted to 0.78±0.11 versus 0.19±0.06 before surgery in group I), but differences were not statistically significant (p>0.05). Statistically significant differences (p=0.046) were observed when comparing best corrected near vision acuity (BCNVA) in groups I and II (0.79±0.05 and 0.98±0.08, respectively) at 6 months compared to the preoperative period (0.62±0.09 and 0.6±0.11, respectively).

CONCLUSION: Trifocal IOL implantation was associated with acceptable near and far vision correction and a higher frequency of adverse optical phenomena, while implantation of the EDOF IOL was associated with slightly better correction of intermediate vision and a significantly lower incidence of halo and glare. Patients were satisfied with the outcomes of surgery in all cases.

PMID:36288415 | DOI:10.17116/oftalma202213805130

Vestn Oftalmol. 2022;138(5):22-28. doi: 10.17116/oftalma202213805122.

ABSTRACT

PURPOSE: To study features of anatomical and morphometric parameters of the structures of anterior eye segment in young patients with moderate and high hyperopia in order to identify the signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack.

MATERIAL AND METHODS: The study included 160 eyes (80 patients) with axial length (AL) of less than 23 mm. Patients with moderate or high hyperopia were divided into two groups according to their age ranges (the 1^st – 27 patients (54 eyes) under 40 years old; the 2^nd – 27 patients (54 eyes) of 41-50 years old, the comparison group – 26 patients (52 eyes) of 42-50 years old with the initial stage of PACG. AL of the eyes, anterior chamber (AC) depth in the central zone, lens thickness (LT) in the optical zone were measured using IOL Master 700 («Carl Zeiss Meditec AG», Germany). AC volume and peripheral AC depth were measured using rotating Scheimpflug camera Pentacam («Oculus», Germany).

RESULTS: While the average values of AL in patients of the 1^st and 2^nd groups were comparable, a statistically significant decrease in AC depth and a significant increase in LT were revealed in the 2^nd group. There was a statistically significant increase in LT, a decrease in peripheral AC depth and AC volume in the comparison group relative to the 2^nd group. In the 1^st group: in 2 eyes of one 38-year-old patient the maximum proximity of all 3 indices to the median values of the group of patients with PACG was found; in 4 eyes of two other patients (35 and 38 years old), a combination of small AC volume with increased LT or small AC volume with small AC on the periphery was noted.

CONCLUSION: Significant differences in terms of LT, peripheral AC depth and AC volume were found between age-comparable (41-50 years old) healthy individuals with short eyes and patients with initial PACG. In 11% of the eyes of healthy patients with hyperopia aged 21 to 40 years, there was a combination of two or three of the studied morphometric signs, which may indicate the risk of developing PACG.

PMID:36288414 | DOI:10.17116/oftalma202213805122

PLoS Biol. 2022 Oct 26;20(10):e3001846. doi: 10.1371/journal.pbio.3001846. eCollection 2022 Oct.

ABSTRACT

Bacterial biofilms are among the most abundant multicellular structures on Earth and play essential roles in a wide range of ecological, medical, and industrial processes. However, general principles that govern the emergence of biofilm architecture across different species remain unknown. Here, we combine experiments, simulations, and statistical analysis to identify shared biophysical mechanisms that determine early biofilm architecture development at the single-cell level, for the species Vibrio cholerae, Escherichia coli, Salmonella enterica, and Pseudomonas aeruginosa grown as microcolonies in flow chambers. Our data-driven analysis reveals that despite the many molecular differences between these species, the biofilm architecture differences can be described by only 2 control parameters: cellular aspect ratio and cell density. Further experiments using single-species mutants for which the cell aspect ratio and the cell density are systematically varied, and mechanistic simulations show that tuning these 2 control parameters reproduces biofilm architectures of different species. Altogether, our results show that biofilm microcolony architecture is determined by mechanical cell-cell interactions, which are conserved across different species.

PMID:36288405 | DOI:10.1371/journal.pbio.3001846

J Med Internet Res. 2022 Oct 26;24(10):e40292. doi: 10.2196/40292.

ABSTRACT

BACKGROUND: Shared decision-making (SDM) is a process aimed at facilitating patient-centered care by ensuring that the patient and provider are actively involved in treatment decisions. In mental health care, SDM has been advocated as a means for the patient to gain or regain control and responsibility over their life and recovery process. To support the process of patient-centered care and SDM, digital tools may have advantages in terms of accessibility, structure, and reminders.

OBJECTIVE: In this randomized controlled trial, we aimed to investigate the effect of a digital tool to support patient activation and SDM.

METHODS: The trial was designed as a randomized, assessor-blinded, 2-armed, parallel-group multicenter trial investigating the use of a digital SDM intervention for 6 months compared with treatment as usual. Participants with a diagnosis of schizophrenia, schizotypal or delusional disorder were recruited from 9 outpatient treatment sites in the Capital Region of Denmark. The primary outcome was the self-reported level of activation at the postintervention time point. The secondary outcomes included self-efficacy, hope, working alliance, satisfaction, preparedness for treatment consultation, symptom severity, and level of functioning. Explorative outcomes on the effect of the intervention at the midintervention time point along with objective data on the use of the digital tool were collected.

RESULTS: In total, 194 participants were included. The intention-to-treat analysis revealed a statistically significant effect favoring the intervention group on patient activation (mean difference 4.39, 95% CI 0.99-7.79; Cohen d=0.33; P=.01), confidence in communicating with one’s provider (mean difference 1.85, 95% CI 0.01-3.69; Cohen d=0.24; P=.05), and feeling prepared for decision-making (mean difference 5.12, 95% CI 0.16-10.08; Cohen d=0.27; P=.04). We found no effect of the digital SDM tool on treatment satisfaction, hope, self-efficacy, working alliance, severity of symptoms, level of functioning, use of antipsychotic medicine, and number or length of psychiatric hospital admissions.

CONCLUSIONS: This trial showed a significant effect of a digital SDM tool on the subjective level of patient activation, confidence in communicating with one’s provider, and feeling prepared for decision-making at the postintervention time point. The effect size was smaller than the 0.42 effect size that we had anticipated and sampled for. The trial contributes to the evidence on how digital tools may support patient-centered care and SDM in mental health care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03554655; https://clinicaltrials.gov/ct2/show/NCT03554655.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-doi: 10.1186/s12888-019-2143-2.

PMID:36287604 | DOI:10.2196/40292

JMIR Res Protoc. 2022 Oct 26;11(10):e40700. doi: 10.2196/40700.

ABSTRACT

BACKGROUND: Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD.

OBJECTIVE: The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients.

METHODS: This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV₁) <80% of expected and a FEV₁/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05.

RESULTS: The recruitment period will last from April 2022 until June 2023.

CONCLUSIONS: If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD.

TRIAL REGISTRATION: ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40700.

PMID:36287602 | DOI:10.2196/40700

JMIR Public Health Surveill. 2022 Oct 26;8(10):e29890. doi: 10.2196/29890.

ABSTRACT

BACKGROUND: According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually.

OBJECTIVE: This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection.

METHODS: A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05.

RESULTS: Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior.

CONCLUSIONS: This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico.

PMID:36287600 | DOI:10.2196/29890

JMIR Pediatr Parent. 2022 Oct 26;5(4):e37581. doi: 10.2196/37581.

ABSTRACT

BACKGROUND: While a variety of health apps abound, less than half of adults in the United States report using a health app, despite the ubiquity of smartphones among users aged 18 to 49 years. Several studies have examined the use of breastfeeding apps; however, less is known about the types of features found on these apps and what factors might influence app ratings.

OBJECTIVE: This paper seeks to characterize breastfeeding apps, assess whether apps with higher user ratings differ from apps with lower user ratings in their tracking and nontracking features, and analyze whether the type and number of features predict user star ratings and whether an app is higher- or lower-rated.

METHODS: Using a cross-sectional design, a convenience sample of breastfeeding apps was culled from the Apple App Store (iOS) and Google Play Store (Android). Content analysis of the apps (N=82) was conducted using a schema of 87 items, which was then compiled into 9 topical indices for breastfeeding, bottle feeding, solid foods, infant health, infant care, technical characteristics, informatics, informational characteristics, and interactivity. Analysis consisted of descriptive statistics, the Mann-Whitney U test, and Spearman rank correlations. Linear regression and binary logistic regression analyses were conducted to determine which features predicted user star ratings.

RESULTS: On average, users rated breastfeeding apps 4.4 of 5 stars. Two-thirds of apps (n=54) were higher rated (≥4.5 stars), and one-third (n=28) were lower rated (<4.5 stars). Higher-rated apps offered more tracking features for breastfeeding, bottle feeding, solid foods, infant health, and infant care than lower-rated apps. The breastfeeding, solid-food, and technical indices explained 17% of user star ratings. For each additional breastfeeding and solid-food feature, we can expect to see a 27% and 35% increase, respectively, in user star ratings. Additionally, as the number of solid-food features increased, the odds that the app is higher rated increased 1.58 times.

CONCLUSIONS: Our findings suggest user ratings are driven in part by tracking features, specifically those related to breastfeeding and solid foods. The proliferation of mobile health apps offers opportunities for parents and caregivers to track behaviors associated with infant feeding and other health metrics in a dynamic, detailed, and comprehensive manner. Hence, breastfeeding apps have the potential to promote and support breastfeeding among users.

PMID:36287596 | DOI:10.2196/37581

Interact J Med Res. 2022 Oct 26;11(2):e39006. doi: 10.2196/39006.

ABSTRACT

BACKGROUND: Multifaceted school-based interventions involving many stakeholders show promise toward the reduction of sedentary behavior (SB) and improved musculoskeletal conditions in schoolchildren. In resource-limited contexts, where schools face multiple, complex demands, broad school-based interventions may not be possible. In these settings, less complex, resource-efficient interventions are more likely to be adopted and implemented. Interventions that are limited to classrooms and that do not require broader stakeholder participation may be more appropriate to lower-resource settings.

OBJECTIVE: The aim of this study was to systematically search for, identify, and summarize the literature on the effectiveness of classroom-based interventions on SB and spinal health in schoolchildren.

METHODS: PubMed, EBSCOhost CINAHL, Web of Science, and Scopus were searched between January 1, 2021, and April 30, 2021. We included experimental studies conducted exclusively in school classrooms that objectively measured classroom SB and spinal health. The search terms related to SB, classroom sitting, and classroom neck and back pain. Studies that reported on objectively measured classroom physical activity and instrumented observation of healthy spinal behavior were included in the review. The included studies were critically appraised using the McMaster critical review form for quantitative studies. The study findings were summarized in tables, and a meta-analysis of homogeneous review outcome data was conducted.

RESULTS: Overall, 12 experimental studies from high-income countries were included: 9 (75%) studies focused on SB, and 3 (25%) focused on spinal health. Of the 9 SB studies, 8 (89%) reported decreases in classroom sitting time. The pooled medium-term effects of a subset of SB interventions showed statistically significant decreases in sitting time (P=.03), whereas short-term effects and long-term effects were not significantly reduced (P=.13 and P=.23, respectively). A meta-analysis of spinal health studies demonstrated statistically significant improvements in spinal behavior during functional tasks (P=.005).

CONCLUSIONS: Classroom-based interventions aimed at reducing SB and improving spinal health may be effective without placing an additional burden on teachers and parents. SB interventions must include strategies to overcome teachers’ and learners’ hedonic motivation to sit during class time. Standardized outcomes for school-based SB are encouraged so that findings from various settings may be pooled to determine the overall effect across studies. The use of standardized functional outcomes in spinal health studies will aid in determining the effectiveness of spinal health interventions across studies.

TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020176080; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176080.

PMID:36287590 | DOI:10.2196/39006