Nevin Manimala

Acad Med. 2024 Feb 27. doi: 10.1097/ACM.0000000000005675. Online ahead of print.

ABSTRACT

PROBLEM: Stigma in health care toward people who inject drugs (PWID) is a well described, significant barrier to quality care, resulting in poor health outcomes. Harm reduction offers a person-centered counter-framework for minimizing harm for people who use drugs. Despite the evidence in support of harm reduction, medical students typically receive minimal training on harm reduction and the care of PWID.

APPROACH: To fill this gap, medical students at University of California, Los Angeles organized around the principles of harm reduction to improve the medical school curriculum related to PWID. Students screened lectures for stigmatizing language and collaborated with faculty to improve lecture materials. They partnered with a community organizer and hosted a mandatory 1-hour lecture and 30-minute discussion introducing the principles of harm reduction within an overdose prevention, recognition, and response training for first-year medical students during medical school orientation in August 2022. An anonymous online pre- and posttest survey, assessing student attitudes toward PWID, was used to evaluate the effects of the training.

OUTCOMES: A total of 156 students completed the pretest survey, and 107 students completed the pre- and posttest survey (68.5% response rate). The overall posttest mean stigma score was 1.8 (standard deviation [SD] = 0.5) and was significantly lower than the pretest mean of 2.1 (SD = 0.7; P < .0001), indicating a reduction in stigma among medical student attitudes after the course. There was statistically significant improvement in attitudes for 7 of 13 component measures.

NEXT STEPS: This analysis demonstrated that the mandatory class has the capacity to improve medical student attitudes toward PWID. The authors plan to further evaluate the program’s effectiveness through measuring and reporting outcomes for future student cohorts. The authors are working with curriculum directors to further incorporate harm reduction principles into other lectures and problem-based learning exercises.

PMID:38412474 | DOI:10.1097/ACM.0000000000005675

Sex Transm Dis. 2024 Mar 1;51(3):214-219. doi: 10.1097/OLQ.0000000000001922. Epub 2024 Jan 3.

ABSTRACT

BACKGROUND: Assisted partner notification services (APS) are widely implemented throughout sub-Saharan Africa. The effectiveness of APS among persons with previously diagnosed human immunodeficiency virus (HIV) infection is uncertain, and there are few published data on the success of integrating referrals for HIV preexposure prophylaxis (PrEP) into APS.

METHODS: Staff in 22 Namibian Ministry of Health and Social Service clinics offered APS to patients newly and previously diagnosed with HIV (index cases [ICs]) between October 2019 and June 2021. Counselors used a structured interview guide to elicit ICs’ sex partners and biological children and assisted ICs to arrange testing of contacts. Contacts testing HIV-positive were linked to HIV services and those 14 years or older testing negative were offered PrEP. The primary outcome was the case-finding index (contacts testing HIV-positive ÷ ICs receiving APS).

RESULTS: Staff provided APS to 1222 (78%) of 1557 newly diagnosed ICs eliciting 1155 sex partners and 649 biological children. Among 280 previously diagnosed ICs, 279 sex partners and 158 biological children were elicited. The case-finding index was higher among ICs with newly diagnosed HIV compared with previously diagnosed HIV (0.14 vs 0.09, P = 0.46), though this difference was not statistically significant. Most sex partners testing HIV-negative were initiated on PrEP (67% in sex partners from newly diagnosed ICs; 74% in sex partners from previously diagnosed ICs).

CONCLUSIONS: Assisted partner notification services successfully identified sex partners and biological children with undiagnosed HIV infection when provided to both newly and previously diagnosed ICs. Integration of referral to PrEP resulted in many HIV-negative partners initiating PrEP.

PMID:38412468 | DOI:10.1097/OLQ.0000000000001922

J Gerontol A Biol Sci Med Sci. 2024 Feb 27:glae061. doi: 10.1093/gerona/glae061. Online ahead of print.

ABSTRACT

BACKGROUND: Dementia often results in postural control impairment, which could signify central nervous system dysfunction. However, no studies have compared postural control characteristics among various types of dementia. This study aimed to compare static postural control in patients with Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), and vascular dementia (VaD).

METHODS: Cross-sectional relationship between the clinical diagnoses (AD, DLB, VaD, or normal cognition [NC]) of outpatients at a memory clinic and their upright postural control characteristics were examined. In the postural control test, participants were instructed to maintain a static upright standing on a stabilometer for 60 seconds under the eyes-open and eyes-closed conditions. Forty postural control parameters, including distance, position, and velocity in the anterior-posterior and medio-lateral directions, derived from the trajectory of the center of mass sway, were calculated. The characteristics of each type of dementia were compared to those of NC, and the differences among the three types of dementia were evaluated using linear regression models.

RESULTS: The study included 1789 participants (1206 with AD, 111 with DLB, 49 with VaD, and 423 with NC). Patients with AD exhibited distinct postural control characteristics, particularly in some distance and velocity parameters, only in the eyes-closed condition. Those with DLB exhibited features in the mean position in the anterior-posterior direction. In patients with VaD, significant differences were observed in most parameters, except power spectrum.

CONCLUSIONS: Patients with AD, DLB and VaD display disease-specific postural control characteristics when compared to cognitively normal individuals.

PMID:38412449 | DOI:10.1093/gerona/glae061

Phys Chem Chem Phys. 2024 Feb 27. doi: 10.1039/d4cp00297k. Online ahead of print.

ABSTRACT

The changes in free energy, enthalpy, and entropy for transfer of a solute from the gas phase into solution are the fundamental thermodynamic quantities that characterize the solvation process. Owing to the development of methods based on free-energy perturbation theory, computation of free energies of solvation has become routine in conjunction with Monte Carlo (MC) statistical mechanics and molecular dynamics (MD) simulations. Computation of the enthalpy change and by inference the entropy change is more challenging. Two methods are considered in this work corresponding to direct averaging for the solvent and solution and to computing the temperature derivative of the free energy in the van’t Hoff approach. The application is for neutral organic solutes in TIP4P water using long MC simulations to improve precision. Definitive results are also provided for pure TIP4P water. While the uncertainty in computed free energies of hydration is ca. 0.05 kcal mol^-1, it is ca. 0.4 kcal mol^-1 for the enthalpy changes from either van’t Hoff plots or the direct method with sampling for 5 billion MC configurations. Partial molar volumes of hydration are also computed by the direct method; they agree well with experimental data with an average deviation of 3 cm³ mol^-1. In addition, the results permit breakdown of the errors in the free energy changes from the OPLS-AA force field into their enthalpic and entropic components. The excess hydrophobicity of organic solutes is enthalpic in origin.

PMID:38412420 | DOI:10.1039/d4cp00297k

West Afr J Med. 2024 Jan 31;41(1):65-73.

ABSTRACT

BACKGROUND: Un-investigated dyspepsia has remained a common encounter among patients seen in primary care in sub-Saharan Africa. A preventive approach through counselling patients on modifications of lifestyle factors related to dyspepsia could be a cost-effective approach to dyspepsia management in primary care in low- and middle-income settings.

OBJECTIVES: The objectives were to describe the sociodemographic patterns of adult patients with un-investigated dyspepsia in the Family Medicine Clinics, Federal Medical Centre, Gusau, Nigeria, to describe the pattern of lifestyle factors among adult patients with un-investigated dyspepsia, to determine the relationship between lifestyle patterns and un-investigated dyspepsia and to describe the specific food types that precipitate dyspepsia among the respondents.

METHODS: A hospital-based cross-sectional study using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia and the Simple Lifestyle Indicator Questionnaire to describe the lifestyle patterns of participants.

RESULTS: Most respondents (66.9%) have healthy dietary patterns however more respondents 66(52.4%) engaged in unhealthy levels of physical exercise. The Stress level was intermediate in majority of respondents (66.1%). There was no statistically significant association between lifestyle indicators and severity of dyspepsia among the respondents although the linear regression model with p-value < 0.01 and < 0.05, revealed stress as a predictor of dyspepsia in this study.

CONCLUSION: There was no relationship between lifestyle indicators and Uninvestigated dyspepsia among the study participants. However, some specific local foods were identified as precipitants of dyspepsia. Primary care physicians may consider a targeted dietary modification counselling approach in managing patients with uninvestigated dyspepsia.

PMID:38412405

Menopause. 2024 Feb 27. doi: 10.1097/GME.0000000000002326. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the effect of noninvasive radiofrequency (RF) with vaginal estrogen (E), and vaginal moisturizer (M) on improving vulvovaginal atrophy (VVA) in women with genitourinary syndrome of menopause.

METHODS: A total of 32 postmenopausal women who met the inclusion criteria were randomized into three intervention arms to receive one of the following treatments: three sessions of noninvasive RF therapy (RF arm); intravaginal estriol cream 1 mg applied daily for 2 weeks, followed by 1 mg applied two times weekly or 1 mg of estradiol vaginal fast-dissolving film applied daily for 2 weeks, followed by 1 mg applied two times weekly (E arm); and intravaginal moisturizer two times a week (M arm). Assessments at baseline and after 4 months were conducted using Vaginal Health Index score, Vaginal Maturation, visual analog scale for VVA symptoms (dyspareunia, dryness, and burning), and Menopause Rating Scale (MRS) for urogenital symptoms. Vaginal wall biopsies were administered to participants who consented, pretreatment and posttreatment (at baseline and after 4 months of follow-up).

RESULTS: After 4 months, the Vaginal Health Index showed an increase of 6.6 points in mean total score in the RF arm, also in the E arm (+7.3 points), with no significant improvement in the M arm (+1.5 points) (interaction effect: RF, E ≠ M, P < 0.001). Regarding vaginal maturation, there was a significant increase in superficial cells in the E arm (+31.3), with no significant changes in the RF (+9.3) and M (-0.5) arms (interaction effect: E ≠ M, P < 0.001). Vaginal pH decreased significantly in the E arm (-1.25), with a similar response in the RF arm (-1.7), with no significant improvement in the M arm (-0.25) (interaction effect: RF, E ≠ M, P < 0.001).There was a significant improvement in the MRS score for VVA symptoms in the three intervention arms, with no predominance of any arm, whereas the improvement in the total MRS score for urogenital symptoms showed a predominance of the RF arm (ΔRF: -7.8; ΔE: -3.5; ΔM: -2.3; RF ≠ E, M). According to histopathologic analysis, there was no statistically significant increase in glycogenation (P = 0.691) or epithelial cone height (P = 0.935), despite an increase in the median delta (difference between pretreatment and posttreatment) in the three intervention arms (glycogenation: RF arm Δ = +118.4%; E arm Δ = +130.9%; M arm Δ = +24.9%; epithelial cone height: RF arm Δ = +33.5%; E arm Δ = +18.6%; M arm Δ = +22.3%).

CONCLUSION: The effect of noninvasive RF on the treatment of vulvovaginal symptoms of genitourinary syndrome of menopause was similar to vaginal estrogen, except for hormonal cytology, and superior to vaginal moisturizer, with improvement in some histomorphometric parameters. These findings are promising, especially for the population that cannot or prefers not to use vaginal estrogen therapy.

PMID:38412393 | DOI:10.1097/GME.0000000000002326

Small. 2024 Feb 27:e2311416. doi: 10.1002/smll.202311416. Online ahead of print.

ABSTRACT

Inkjet-printing of graphene, iGr, provides an alternative route for the fabrication of highly conductive and flexible graphene films for use in devices. However, the contribution of quantum phenomena associated with 2D single layer graphene, SLG, to the charge transport in iGr is yet to be explored. Here, the first magneto-transport study of iGr in high magnetic fields up to 60 T is presented. The observed quantum phenomena, such as weak localization and negative magnetoresistance, are strongly affected by the thickness of the iGr film and can be explained by a combination of intra- and inter-flake classical and quantum charge transport. The quantum nature of carrier transport in iGr is revealed using temperature, electric field, and magnetic field dependences of the iGr conductivity. These results are relevant for the exploitation of inkjet deposition of graphene, which is of particular interest for additive manufacturing and 3D printing of flexible and wearable electronics. It is shown that printed nanostructures enable ensemble averaging of quantum interference phenomena within a single device, thereby facilitating comparison between experiment and underlying statistical models of electron transport.

PMID:38412384 | DOI:10.1002/smll.202311416

Fam Pract. 2024 Feb 27:cmae010. doi: 10.1093/fampra/cmae010. Online ahead of print.

ABSTRACT

BACKGROUND: The burden of type 2 diabetes mellitus (T2DM) in China continues to escalate.

OBJECTIVE: To investigate the impact of family support system on the self-management behaviour of patients with T2DM.

METHODS: In this cross-sectional study, 1,042 participants were sampled using a multistage stratified probability-proportionate-to-size method. On-site interviews were conducted using a structured questionnaire administered by 122 family doctors from 13 community health service centres in 8 administrative districts. A structural equation model was established to investigate the impact of individual factors and family support system on the self-management behaviour of T2DM patients. Statistical analysis was performed using the SPSS 25.0 software.

RESULTS: The self-management behaviour pass rate among individuals with T2DM was 40.9%. In terms of individual factors, those with a high school education level or above demonstrated higher self-management behaviour scores than those with a junior high school education level or lower. The structural equation model revealed a path of interactions among individual factors, family support system-related factors, and the self-management behaviour of patients with T2DM: Family function → Family support → Patients’ self-management behaviour → Quality of life. The coefficient of the direct path from family function to family support was 0.74 (P < 0.001), while the coefficient of the direct path from family support to self-management behaviour was 0.68 (P = 0.001).

CONCLUSION: There is significant room for improvement in the self-management behaviour of T2DM patients in China. Family function can enhance the self-management behaviour of T2DM patients by promoting family support.

PMID:38412362 | DOI:10.1093/fampra/cmae010

Cancer Epidemiol Biomarkers Prev. 2024 Feb 27. doi: 10.1158/1055-9965.EPI-23-1293. Online ahead of print.

ABSTRACT

BACKGROUND: Distinguishing ovarian cancer (OC) from other gynecological malignancies is crucial for patient survival yet hindered by non-specific symptoms and limited understanding of OC pathogenesis. Accumulating evidence suggests a link between OC and deregulated lipid metabolism. Most studies have small sample sizes, especially for early-stage cases, and lack racial/ethnic diversity, necessitating more inclusive research for improved OC diagnosis and prevention.

METHODS: Here, we profiled the serum lipidome of 208 OC, including 93 patients with early-stage OC, and 117 non-OC (other gynecological malignancies) patients of Korean descent. Serum samples were analyzed with a high-coverage liquid chromatography high-resolution mass spectrometry platform, and lipidome alterations were investigated via statistical and machine learning approaches.

RESULTS: We found lipidome alterations unique to OC were present in Korean women as early as when the cancer is localized, and those changes increase in magnitude as the diseases progresses. Analysis of relative lipid abundances revealed specific patterns for various lipid classes, with most classes showing decreased abundance in OC in comparison to other gynecological diseases. Machine learning methods selected a panel of 17 lipids that discriminated OC from non-OC cases with an AUC of 0.85 for an independent test set.

CONCLUSIONS: This study provides a systemic analysis of lipidome alterations in human OC, specifically in Korean women.

IMPACT: Here, we show the potential of circulating lipids in distinguishing OC from non-OC conditions.

PMID:38412029 | DOI:10.1158/1055-9965.EPI-23-1293

United European Gastroenterol J. 2024 Feb 27. doi: 10.1002/ueg2.12541. Online ahead of print.

ABSTRACT

BACKGROUND: Faecal incontinence is a common debilitating condition associated with poor quality of life that generates substantial economic strain on healthcare systems.

OBJECTIVES: We aimed to evaluate, in a tertiary referral population presenting with faecal incontinence, the impact of suffering additional disorders of gut-brain interaction (DGBI) on symptom severity, anxiety, depression and quality of life.

METHODS: Design: Retrospective cohort study.

SETTING: Tertiary referral Neurogastroenterology centre.

PATIENTS: All patients presenting with faecal incontinence from 2007 to 2020 were included.

MAIN OUTCOME MEASURES: The results from structured medical and surgical questionnaires including Rome III Integrative Questionnaire, Faecal Incontinence Severity Index, Hospital Anxiety and Depression Scale, SF-36, and anorectal physiology were analysed using Stata version 17. Patients were categorised into 3 groups: 0-1 additional DGBI, 2 DGBIs, and 3+ DGBI. Statistical significance was defined as p < 0.05 (two-tailed).

KEY RESULTS: Faecal incontinence patients (n = 249; mean age 63.4 ± 12.6 years; 93.6% female, 48.1% urge subtype) met diagnostic criteria for mean 2.2 additional DGBI each, mostly affecting bowel (n = 231, 42.4%) and anorectal (n = 150, 27.5%) regions. A greater number of DGBIs was associated with higher faecal incontinence symptom severity (p < 0.001), higher anxiety (p = 0.002) and depression (p = 0.003), and worse quality of life in areas of mental health (p = 0.037) and social effect (p < 0.001). Patients with a greater number of concurrent DGBI demonstrated a greater family history of gastrointestinal problems (p = 0.004). There were no associations found between a greater amount of DGBIs and anorectal physiology.

CONCLUSIONS AND INFERENCES: A greater number of additional DGBIs in faecal incontinence patients was associated with worse faecal incontinence symptoms, higher anxiety and depression scores, and worse quality of life but was unrelated to physiology. This highlights the need to proactively search for comorbid DGBI in patients presenting with faecal incontinence.

PMID:38412024 | DOI:10.1002/ueg2.12541