Nevin Manimala

Psychiatr Pol. 2023 Oct 16:1-22. doi: 10.12740/PP/OnlineFirst/169912. Online ahead of print.

ABSTRACT

OBJECTIVES: This study aimed to investigate incidences of stigmatisation and discrimination by selected health professionals against patients with HIV/AIDS and HCV, and to assess how these affected feelings in both groups.

METHODS: The study involved 160 patients – 80 diagnosed with HIV/AIDS in the baseline group and 80 with HCV in the comparison group. Patients were recruited from among patients treated in two outpatient clinics of the University Hospital in Krakow.

RESULTS: Incidents of stigmatisation and discrimination were observed significantly more often in the HIV/AIDS group compared to the HCV group. According to the patients, incidents of stigmatisation and discrimination on the part of medical staff occur due to fear and a sense of threat from infection with the viruses. The experience of stigmatisation and discrimination by patients manifests itself in the impediment or denial of healthcare services by medical professionals. Some of the medical staff blamed the patients for the infection, expressed disrespect and verbal aggression towards them, and treated them worse when they found out about the infection. Their emotional state depended on the nature of the relationship with the medical staff triggered by stigmatisation and discrimination.

CONCLUSIONS: Stigmatisation and discrimination by medical staff against patients were, according to the respondents, linked to fear of infection but confirmation of this relationship would require further research. In the course of these cases, patients experienced pejorative verbal evaluation, impediment or denial of health services, which could have specific health consequences. These types of attitudes had a negative impact on their emotional state.

PMID:38452318 | DOI:10.12740/PP/OnlineFirst/169912

Rheumatology (Oxford). 2024 Mar 7:keae140. doi: 10.1093/rheumatology/keae140. Online ahead of print.

ABSTRACT

OBJECTIVES: To investigate cancer risk in rheumatoid arthritis (RA) patients treated with tocilizumab/sarilumab, abatacept, or rituximab compared with those who received tumour necrosis factor inhibitors (TNFi) and compared with biological disease-modifying anti-rheumatic drugs (bDMARD) naïve RA patients.

METHODS: Nationwide registry-based cohort study of RA patients initiating treatment with tocilizumab/sarilumab, abatacept, rituximab, TNFi, and bDMARD-naive patients their second type of conventional synthetic DMARD (csDMARD). Patients were identified in DANBIO and followed for cancer from 2006-2020. Patients could contribute multiple treatments, with person years (PYRS), deaths, and cancers allocated to each treatment group in a ‘latest type of treatment’ manner. Inverse probability of treatment weighting and weighted cause-specific Cox models were used to calculate hazard ratios (HRs) for cancer in each tocilizumab/sarilumab, abatacept, and rituximab group compared with TNFI and bDMARD naïve groups, respectively.

RESULTS: In total, 21 982 treatment initiations, 96 475 PYRS, and 1423 cancers were identified. There were no statistically significant increased HRs for overall cancer in tocilizumab/sarilumab, abatacept, or rituximab treatment groups (HRs ranged from 0.7-1.1). More than five years of abatacept exposure showed a non-significantly increased HR compared with TNFi (HR 1.41, 95% confidence intervals CI 0.74-2.71). For hematological cancers, rituximab treatment showed non-significantly reduced HRs: vs TNFi (HR 0.09; 95%CI 0.00-2.06) and bDMARD-naïve (HR 0.13; 95%CI 0.00-1.89).

CONCLUSION: Treatment with tocilizumab/sarilumab, abatacept, or rituximab in RA patients was not associated with increased risks of cancer compared with TNFi-treated and with bDMARD-naïve RA patients in a real-world setting.

PMID:38452297 | DOI:10.1093/rheumatology/keae140

J Am Med Inform Assoc. 2024 Mar 7:ocae004. doi: 10.1093/jamia/ocae004. Online ahead of print.

ABSTRACT

OBJECTIVE: The timely initiation of renal replacement therapy (RRT) for acute kidney injury (AKI) requires sequential decision-making tailored to individuals’ evolving characteristics. To learn and validate optimal strategies for RRT initiation, we used reinforcement learning on clinical data from routine care and randomized controlled trials.

MATERIALS AND METHODS: We used the MIMIC-III database for development and AKIKI trials for validation. Participants were adult ICU patients with severe AKI receiving mechanical ventilation or catecholamine infusion. We used a doubly robust estimator to learn when to start RRT after the occurrence of severe AKI for three days in a row. We developed a “crude strategy” maximizing the population-level hospital-free days at day 60 (HFD60) and a “stringent strategy” recommending RRT when there is significant evidence of benefit for an individual. For validation, we evaluated the causal effects of implementing our learned strategies versus following current best practices on HFD60.

RESULTS: We included 3748 patients in the development set and 1068 in the validation set. Through external validation, the crude and stringent strategies yielded an average difference of 13.7 [95% CI -5.3 to 35.7] and 14.9 [95% CI -3.2 to 39.2] HFD60, respectively, compared to current best practices. The stringent strategy led to initiating RRT within 3 days in 14% of patients versus 38% under best practices.

DISCUSSION: Implementing our strategies could improve the average number of days that ICU patients spend alive and outside the hospital while sparing RRT for many.

CONCLUSION: We developed and validated a practical and interpretable dynamic decision support system for RRT initiation in the ICU.

PMID:38452293 | DOI:10.1093/jamia/ocae004

Harv Rev Psychiatry. 2024 Mar-Apr 01;32(2):58-62. doi: 10.1097/HRP.0000000000000392.

ABSTRACT

Since the inclusion of gender identity disorder in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), psychiatry and the broader medical field have made substantial alterations in their recognition of and respect for transgender and gender diverse (TGD) identities. As this recognition continues to expand, psychiatrists should be aware of both historical harm and current best care practices, especially in light of psychiatric morbidity in TGD populations relative to the general population. This article contextualizes the history of psychiatry’s engagement with TGD patients and presents the gender minority stress and resilience model to frame the mental health disparities experienced by TGD people. We envision a role for psychiatry that goes beyond gatekeeping gender-affirming hormone therapy and surgeries. Instead, we should invest in equitable care across the continuum of mental health needs. We provide an overview of existing literature to help characterize psychiatric epidemiology for this population, with the goal of offering guidance on how psychiatrists can deliver responsive and high-quality care for TGD people. Some key areas of proposed clinical improvement include culturally tailoring interventions for substance use disorders, reducing medical trauma in acute psychiatric care settings, and better understanding the interplay of psychopharmacology and gender-affirming hormone therapy.

PMID:38452285 | DOI:10.1097/HRP.0000000000000392

J Evol Biol. 2024 Mar 7:voae025. doi: 10.1093/jeb/voae025. Online ahead of print.

ABSTRACT

Members of the genus Clivia show considerable variation in flower pigmentation and morphology. Such variation is effected by mutations that emerge in candidate flower development genes over time. Besides population history, mutations can further illuminate the effects of demographic events in populations in addition to population genetic parameters including selection, recombination, and linkage disequilibrium (LD). The current study aimed to find sequence variants in two anthocyanin biosynthetic genes (DFR and bHLH) of Clivia miniata and use the data to assess population genetic factors from a random collection of orange/red- and yellow-flowered specimens. Overall, average nucleotide diversity in the two anthocyanin genes was moderate (π = 0.00646), whereas haplotypes differed significantly (Hd ≥ 0.9). Gene evolution was seemingly driven by mutations (CmiDFR) or recombination (CmibHLH001). LD decayed swiftly within the analyzed gene regions and supported the feasibility of assessing trait-variant associations via the association/linkage mapping approach. In the end, most associations were found to be spurious, but one haplotype in CmibHLH001 showed a promising correlation to the orange/red flower phenotype in Clivia specimens. In all, the present study is the first to measure gene-level diversity in C. miniata – data that had never been reported so far. Further, the study also identified allelic and haplotypic variants that may be beneficial in future association genetic studies of Clivia. Such studies, however, consider large diverse populations to control for statistical bias intrinsic to the analysis of small datasets.

PMID:38452247 | DOI:10.1093/jeb/voae025

J Gerontol A Biol Sci Med Sci. 2024 Mar 7:glae077. doi: 10.1093/gerona/glae077. Online ahead of print.

ABSTRACT

Alzheimer’s disease is strongly linked to metabolic abnormalities. We aimed to distinguish amyloid-positive people who progressed to cognitive decline from those who remained cognitively intact. We performed untargeted metabolomics of blood samples from amyloid-positive individuals, before any sign of cognitive decline, to distinguish individuals who progressed to cognitive decline from those who remained cognitively intact. A plasma-derived metabolite signature was developed from Supercritical Fluid chromatography coupled with high-resolution mass spectrometry (SFC-HRMS) and nuclear magnetic resonance (NMR) metabolomics. The two metabolomics datasets were analyzed by Data Integration Analysis for Biomarker discovery using Latent approaches for Omics studies (DIABLO), to identify a minimum set of metabolites that could describe cognitive decline status. NMR or SFC-HRMS data alone cannot predict cognitive decline. However, among the 320 metabolites identified, a statistical method that integrated the two datasets enabled identification of a minimal signature of 9 metabolites (3-hydroxybutyrate, citrate, succinate, acetone, methionine, glucose, serine, sphingomyelin d18:1/C26:0 and triglyceride C48:3) with a statistically significant ability to predict cognitive decline more than 3 years before decline. This metabolic fingerprint obtained during this exploratory study may help to predict amyloid-positive individuals who will develop cognitive decline. Due to the high prevalence of brain amyloid-positivity in older adults, identifying adults who will have cognitive decline will enable the development of personalized and early interventions.

PMID:38452244 | DOI:10.1093/gerona/glae077

Eur J Orthod. 2024 Apr 1;46(2):cjae011. doi: 10.1093/ejo/cjae011.

ABSTRACT

OBJECTIVES: The rapid advancement of Large Language Models (LLMs) has prompted an exploration of their efficacy in generating PICO-based (Patient, Intervention, Comparison, Outcome) queries, especially in the field of orthodontics. This study aimed to assess the usability of Large Language Models (LLMs), in aiding systematic review processes, with a specific focus on comparing the performance of ChatGPT 3.5 and ChatGPT 4 using a specialized prompt tailored for orthodontics.

MATERIALS/METHODS: Five databases were perused to curate a sample of 77 systematic reviews and meta-analyses published between 2016 and 2021. Utilizing prompt engineering techniques, the LLMs were directed to formulate PICO questions, Boolean queries, and relevant keywords. The outputs were subsequently evaluated for accuracy and consistency by independent researchers using three-point and six-point Likert scales. Furthermore, the PICO records of 41 studies, which were compatible with the PROSPERO records, were compared with the responses provided by the models.

RESULTS: ChatGPT 3.5 and 4 showcased a consistent ability to craft PICO-based queries. Statistically significant differences in accuracy were observed in specific categories, with GPT-4 often outperforming GPT-3.5.

LIMITATIONS: The study’s test set might not encapsulate the full range of LLM application scenarios. Emphasis on specific question types may also not reflect the complete capabilities of the models.

CONCLUSIONS/IMPLICATIONS: Both ChatGPT 3.5 and 4 can be pivotal tools for generating PICO-driven queries in orthodontics when optimally configured. However, the precision required in medical research necessitates a judicious and critical evaluation of LLM-generated outputs, advocating for a circumspect integration into scientific investigations.

PMID:38452222 | DOI:10.1093/ejo/cjae011

Scand J Pain. 2024 Mar 7;24(1). doi: 10.1515/sjpain-2023-0035. eCollection 2024 Jan 1.

ABSTRACT

OBJECTIVES: Pain catastrophizing in the aging population has not been studied in great detail. Existing investigations have reported conflicting results on the effects of age on pain catastrophizing in relation to pain responses. This study investigated the relationship between pain catastrophizing, and its individual components (rumination, magnification, and helplessness), and the responses to standardized experimental pain stimuli in old and young, healthy adults.

METHODS: Sixty-six volunteers (32 old: 65-87, 18 females; 34 young: 20-35, 17 females) participated in the study. Pain catastrophizing including the components of rumination, magnification, and helplessness was assessed with the pain catastrophizing scale (PCS). Experimental pain was induced by applying predefined pressure stimulations to the trapezius muscle. Pain intensity and unpleasantness were assessed using numerical rating scales. Pain catastrophizing levels and pain responses were statistically compared between the two age groups.

RESULTS: Elderly individuals reported significantly (p = 0.028) lower scores of pain catastrophizing (Med = 5; interquartile range [IQR] = 14) than younger individuals; this difference was driven by the significantly lower components of rumination (Med = 2; IQR = 4; p = 0.017) and helplessness (Med = 2; IQR = 7; p = 0.049). A larger proportion of young (57.8%) rated pain catastrophizing at high levels, with scores above the 75th percentile (Med = 20). Additionally, elderly reported the lowest pain intensity (Med = 5; p = 0.034) and pain unpleasantness (Med = 4.5; p = 0.011) responses to the experimental pressure stimuli. In the elderly group, pain unpleasantness was positively and significantly associated with pain catastrophizing (r _s = 0.416, p = 0.021), rumination (r _s = 0.42, p = 0.019), and helplessness (r _s = 0.434, p = 0.015), respectively. No associations were found in the young group.

CONCLUSIONS: Elderly reported lower PCSs than young adults. Rumination and helplessness were reduced in the elderly group. The elderly population showed positive correlations between catastrophizing levels and pain unpleasantness to standardized pressure pain stimuli. Results supported the view that elderly possess resilience over specific domains of pain catastrophizing that could counteract pain perception due to physiological decline.

PMID:38452201 | DOI:10.1515/sjpain-2023-0035

Prev Chronic Dis. 2024 Mar 7;21:E15. doi: 10.5888/pcd21.230220.

ABSTRACT

PURPOSE AND OBJECTIVES: Although considered a promising model of practice, integrating healthy nutrition standards and practices into a large county government’s contracting process with food vendors has not been widely described in empirical literature. We conducted an implementation evaluation project to address this gap.

INTERVENTION APPROACH: County of Los Angeles food vendors provide food or meals annually to more than 100,000 employees and millions of clients and visitors. In 2011, the County of Los Angeles Board of Supervisors adopted a policy to integrate healthy nutrition standards and practices into its requests for proposals (RFPs) and contracting process with food vendors. The policy required all contracts awarded to adhere to these new standards.

EVALUATION METHODS: In 2011, the Los Angeles County Department of Public Health (DPH) began reviewing RFPs for food services for county departments that procured, served, or sold food. From 2011 through 2021, DPH applied a 4-pronged formative-evaluative approach to help county departments implement the Board of Supervisors policy and ensure that nutritional requirements were appropriately integrated into all RFPs for new and renewing contracts with food vendors. We focused our evaluation on understanding the process and tracking the progress of this policy intervention. Our evaluation included 13 key informant interviews, a 2-part survey, reviews of contract data, and synthesis of lessons learned.

RESULTS: Based on reviews and subsequent actions taken on more than 20 RFPs, DPH successfully assisted 7 county departments to incorporate healthy nutrition standards and practices into their food vendor contracts. Implementation of the food policy encountered several challenges, including staffing and training constraints and a limited infrastructure. An iterative approach to program improvement facilitated the process.

IMPLICATIONS FOR PUBLIC HEALTH: Although the model for integrating healthy nutrition standards and practices into a government contracting process is promising, more work is needed to make it less resource-intensive and to increase user buy-in.

PMID:38452193 | DOI:10.5888/pcd21.230220

Braz J Biol. 2024 Feb 26;83:e277354. doi: 10.1590/1519-6984.277354. eCollection 2024.

ABSTRACT

This study aimed to explore the diuretic activity of linalyl acetate (LA). LA is an essential oil, it is an integral phyto-constituent of various plants. In this study, acute and chronic diuretic activities were explored by measuring the levels of different electrolytes and pH in the urine of experimental rats. Rats were divided into five groups. The control group was given 10 mg/kg normal saline, the treated group was given 10 mg/kg furosemide, and the remaining 3 groups received different doses of LA including 25, 50, and 75 mg/kg through intraperitoneal route, to determine its diuretic potential. Urine volume for acute diuretic activity was measured for 6 hours however for chronic diuretic activity was measured for 6 days. For a comparative study of LA with a control group and treated group with reference drug, diuretic index was used. Moreover, the underlying mechanism of the diuretic activity was also explored by comparing atropine, L-NAME, and indomethacin. The results of each group with 6 rats in each group were obtained by ± standard error of the mean of every group. Analysis of Variance (ANOVA) was used for statistical analysis. Results revealed that the LA 75 mg/kg dose showed comparable results as of furosemide. Moreover, this study revealed the involvement of muscarinic receptors to produce diuresis in comparison with atropine with very little involvement of prostanoids and no effect on NO pathway induced by indomethacin and L-NAME respectively. It is concluded that LA possess anti-diuretic potential. Muscarinic receptors might be involved in producing diuretic effects.

PMID:38452187 | DOI:10.1590/1519-6984.277354