Nevin Manimala

JMIR Res Protoc. 2023 Nov 3;12:e44907. doi: 10.2196/44907.

ABSTRACT

BACKGROUND: Academic procrastination is a widespread problem among college students. It is linked to poor academic performance and increased college dropout intentions, as well as several mental health problems such as depression, anxiety, and stress. Guided web-based interventions can help reduce procrastination. However, guidance by professional clinicians draws upon valuable and limited societal resources, and a more efficient, scalable form of guidance is needed. Guidance by trained clinical psychology students has not yet been examined.

OBJECTIVE: The aim of this open trial is to examine the feasibility and acceptability of a web-based procrastination intervention for college students under the guidance of student digital coaches (e-coaches).

METHODS: We developed a single-arm trial of a guided web-based intervention targeting procrastination for the Dutch student population. Guidance is delivered by trained clinical psychology students asynchronously in the form of textual feedback on intervention progress, with the aim of supporting and motivating the participant. Participants are recruited at 7 Dutch universities. Primary outcomes are intervention satisfaction, usability, and adherence, which are assessed by the Client Satisfaction Scale (CSQ-8), System Usability Scale (SUS-10), and number of completed modules, respectively. The primary outcomes will be examined by calculating descriptive statistics. Secondary outcomes are e-coach satisfaction and changes to procrastination, depression, stress, and quality of life from pre- to posttest and follow-up.

RESULTS: The project was funded in 2019, and recruitment began in January 2021. As of May 2023, a total of 985 participants were enrolled, of which 372 had completed the posttest and 192 had completed the follow-up. The expected date of analysis and publication of the results is 2024.

CONCLUSIONS: The results are expected to contribute to the body of literature regarding eHealth in 3 ways. First, we will examine whether students who procrastinate adhere to and are satisfied with an eHealth intervention targeting this problem. Second, we will explore whether an intervention targeting procrastination can also decrease depression and stress. Lastly, we will investigate whether trained psychology students can effectively guide their peers in web-based interventions. Given the shortage of licensed psychologists, exploring alternative sources of guidance is much needed in order to provide students with the mental health support they need.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44907.

PMID:37921841 | DOI:10.2196/44907

J Nutr Educ Behav. 2023 Oct 31:S1499-4046(23)00528-6. doi: 10.1016/j.jneb.2023.10.007. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess change in attitudes toward women who have experienced trauma and to describe interns’ reflections regarding the provision of universal trauma precautions and the training sessions.

METHODS: Dietetic interns participated in 3 2-hour trauma-informed care (TIC) training sessions. A multiple-methods design was used, incorporating a presurvey and postsurvey to assess change in attitudes and thematic analysis to assess self-reflections.

RESULTS: The attitudes of the interns improved across all statements. Two components measuring attitudes about sympathetic feelings toward mothers with underlying trauma and substance use disorder during pregnancy and retaining custody of their children reached statistical significance (P < 0.05). Four themes were identified in the self-reflections: TIC training was informative, valuable, and warranted, and interns felt comfortable discussing TIC.

CONCLUSIONS AND IMPLICATIONS: Students positively assessed the TIC training and changed their attitudes. Trauma-informed care can be effectively incorporated within dietetics education to support students in developing therapeutic relationships in their future nutrition care standards.

PMID:37921798 | DOI:10.1016/j.jneb.2023.10.007

J Nutr Educ Behav. 2023 Nov 1:S1499-4046(23)00527-4. doi: 10.1016/j.jneb.2023.10.006. Online ahead of print.

ABSTRACT

OBJECTIVE: We investigated the relationship between nutrition literacy, diet quality, carotenoid status, and cognition.

METHODS: Adults aged 37.5 ± 17.0 years (n = 52) completed the 42-item Nutrition Literacy Assessment Instrument (NLit). The Dietary History Questionnaire III was analyzed to determine the Healthy Eating Index. Skin carotenoids were assessed as a diet quality biomarker. Selective attention, relational memory, and pattern separation abilities were assessed using the flanker, spatial reconstruction, and mnemonic similarity tasks, respectively. Statistical adjustments included age, sex, education, and body mass index.

RESULTS: No correlations were observed for NLit scores and NLit subscales with Healthy Eating Index and skin carotenoid status. However, the NLit’s food label and numeracy subscale was related to greater pattern separation abilities (ρ = 0.33, r² = 0.11, P = 0.03).

CONCLUSIONS AND IMPLICATIONS: Comprehension of food labels and numeracy information was associated with memory abilities. Future work is needed to test whether targeting working memory and attentional processes during memory retrieval in larger samples may facilitate the acquisition of nutrition knowledge.

PMID:37921796 | DOI:10.1016/j.jneb.2023.10.006

JACC Clin Electrophysiol. 2023 Oct 12:S2405-500X(23)00729-6. doi: 10.1016/j.jacep.2023.09.009. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic sleep disruption is associated with incident atrial fibrillation (AF), but it is unclear whether poor sleep quality acutely triggers AF.

OBJECTIVE: The aim of this study was to characterize the relationship between a given night’s sleep quality and the risk of a discrete AF episode.

METHODS: Patients with symptomatic paroxysmal AF in the I-STOP-AFIB (Individualized Studies of Triggers of Paroxysmal Atrial Fibrillation) trial reported sleep quality on a daily basis. Participants were also queried daily regarding AF episodes and were provided smartphone-based mobile electrocardiograms (ECGs) (KardiaMobile; AliveCor).

RESULTS: Using 15,755 days of data from 419 patients, worse sleep quality on any given night was associated with a 15% greater odds of a self-reported AF episode the next day (OR: 1.15; 95% CI: 1.10-1.20; P < 0.0001) after adjustment for the day of the week. No statistically significant associations between worsening sleep quality and mobile ECG-confirmed AF events were observed (OR: 1.04; 95% CI: 0.95-1.13; P = 0.43), although substantially fewer of these mobile ECG-confirmed events may have limited statistical power. Poor sleep was also associated with longer self-reported AF episodes, with each progressive category of worsening sleep associated with 16 (95% CI: 12-21; P < 0.001) more minutes of AF the next day.

CONCLUSIONS: Poor sleep was associated with an immediately heightened risk for self-reported AF episodes, and a dose-response relationship existed such that progressively worse sleep was associated with longer episodes of AF the next day. These data suggest that sleep quality may be a potentially modifiable trigger relevant to the near-term risk of a discrete AF episode.

PMID:37921790 | DOI:10.1016/j.jacep.2023.09.009

JAMA Netw Open. 2023 Nov 1;6(11):e2340597. doi: 10.1001/jamanetworkopen.2023.40597.

ABSTRACT

IMPORTANCE: An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support.

OBJECTIVE: To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC).

DESIGN, SETTING, AND PARTICIPANTS: This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021.

INTERVENTION: Prior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started.

MAIN OUTCOMES AND MEASURE: The primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome.

RESULTS: Among 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, -2.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups.

CONCLUSIONS AND RELEVANCE: This study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03916159.

PMID:37921769 | DOI:10.1001/jamanetworkopen.2023.40597

JAMA Netw Open. 2023 Nov 1;6(11):e2340859. doi: 10.1001/jamanetworkopen.2023.40859.

ABSTRACT

IMPORTANCE: After the initial disruption from the COVID-19 pandemic, it is unclear how patterns of e-cigarette use in the US have changed.

OBJECTIVE: To examine recent patterns in current and daily e-cigarette use among US adults in 2021.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) database. The BRFSS is the largest national telephone-based survey of randomly sampled adults in the US. Adults aged 18 years or older, residing in 49 US states (all except Florida), the District of Columbia, and 3 US territories (Guam, Puerto Rico, and the US Virgin Islands), were included in the data set. Data analysis was performed in January 2023.

MAIN OUTCOMES AND MEASURES: The main outcome was age-adjusted prevalence of current and daily e-cigarette use overall and by participant characteristics, state, and territory. Descriptive statistical analysis was conducted, applying weights to account for population representation.

RESULTS: This study included 414 755 BRFSS participants with information on e-cigarette use. More than half of participants were women (51.3%). In terms of race and ethnicity, 0.9% of participants were American Indian or Alaska Native, 5.8% were Asian, 11.5% were Black, 17.3% were Hispanic, 0.2% were Native Hawaiian or Other Pacific Islander, 62.2% were White, 1.4% were of multiple races or ethnicities, and 0.6% were of other race or ethnicity. Individuals aged 18 to 24 years comprised 12.4% of the study population. The age-standardized prevalence of current e-cigarette use was 6.9% (95% CI, 6.7%-7.1%), with almost half of participants using e-cigarettes daily (3.2% [95% CI, 3.1%-3.4%]). Among individuals aged 18 to 24 years, there was a consistently higher prevalence of e-cigarette use, with more than 18.6% reporting current use and more than 9.0% reporting daily use. Overall, among individuals reporting current e-cigarette use, 42.2% (95% CI, 40.7%-43.7%) indicated former combustible cigarette use, 37.1% (95% CI, 35.6%-38.6%) indicated current combustible cigarette use, and 20.7% (95% CI, 19.7%-21.8%) indicated never using combustible cigarettes. Although relatively older adults (aged ≥25 years) who reported current e-cigarette use were more likely to report former or current combustible cigarette use, younger adults (aged 18-24 years) were more likely to report never using combustible cigarettes. Notably, the proportion of individuals who reported current e-cigarette use and never using combustible cigarettes was higher in the group aged 18 to 20 years (71.5% [95% CI, 66.8%-75.7%]) compared with those aged 21 to 24 years (53.0% [95% CI, 49.8%-56.1%]).

CONCLUSION AND RELEVANCE: These findings suggest that e-cigarette use remained common during the COVID-19 pandemic, particularly among young adults aged 18 to 24 years (18.3% prevalence). Notably, 71.5% of individuals aged 18 to 20 years who reported current e-cigarette use had never used combustible cigarettes. These results underscore the rationale for the implementation and enforcement of public health policies tailored to young adults.

PMID:37921768 | DOI:10.1001/jamanetworkopen.2023.40859

JAMA Netw Open. 2023 Nov 1;6(11):e2341402. doi: 10.1001/jamanetworkopen.2023.41402.

ABSTRACT

IMPORTANCE: Breast cancer (BC) is the leading cancer among women in Namibia. Examining the BC journey in this multiracial country where inequalities remain large is needed to inform effective interventions to reduce BC mortality.

OBJECTIVE: To describe the entire BC journey of Namibian women by race, utilizing the World Health Organization Global Breast Cancer Initiative (GBCI) framework.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Namibian subset of the African Breast Cancer-Disparities in Outcomes prospective cohort. Participants were all Namibian residents with confirmed incident BC who presented at the main national public oncology center of the Windhoek Central Hospital (WCH). Follow-up started from recruitment (September 8, 2014, to October 5, 2016) and ended up to 3 years after diagnosis (December 13, 2014, to September 27, 2019). Data analysis was conducted from June 2022 to August 2023.

EXPOSURES: Participants’ self-reported ethnicities were aggregated into 3 population groups: Black, mixed ancestry, and White.

MAIN OUTCOMES AND MEASURES: Three-year overall survival (OS) was examined using Cox models, and summary statistics were used to describe women’s BC journey, including GBCI pillar key performance indicators: (1) early stage (TNM I or II) diagnosis (population benchmark ≥60%), (2) prompt diagnosis, ie, 60 days or less to first health care practitioner visit (population benchmark 100%), and (3) completion of recommended multimodal treatment (MT, ie, surgery plus chemotherapy) (population benchmark ≥80%).

RESULTS: Of 405 women, there were 300 (74%) Black (mean [SD] age, 53 [15] years), 49 (12%) mixed ancestry (mean [SD] age, 53 [7] years), and 56 (14%) White (mean [SD] age, 59 [12] years) patients. Three-year OS was lowest in Black women (60% [95% CI, 54%-66%]; mixed ancestry: 80% [95% CI, 65%-89%]; White: 89% [95% CI, 77%-95%]), who had lower prevalence of early stage diagnosis (Black: 37% [95% CI, 31%-42%]; mixed ancestry and White: 75% [95% CI, 66%-83%]) and timely diagnosis (Black: 60% [95% CI, 54%-66%]; mixed ancestry and White: 77% [95% CI, 69%-85%]), while MT completion (Black: 53% [95% CI, 46%-59%]; mixed ancestry and White: 63% [95% CI, 50%-73%]) was low in all women.

CONCLUSIONS AND RELEVANCE: In this cohort study of 405 Namibian residents with BC, marked racial disparities in survival were paralleled by inequities all along the BC journey. To improve BC survival, interventions are needed to promote earlier diagnosis in Black Namibian women and to increase MT initiation and completion in all women.

PMID:37921764 | DOI:10.1001/jamanetworkopen.2023.41402

J Perianesth Nurs. 2023 Nov 3:S1089-9472(23)00886-9. doi: 10.1016/j.jopan.2023.07.013. Online ahead of print.

ABSTRACT

PURPOSE: The study was conducted to determine the effect of preoperative pain, fear, and anxiety on postoperative pain and analgesia use in urology patients.

DESIGN: A descriptive and correlational design was used.

METHODS: The population of the study consisted of patients who were hospitalized in the Urology clinic of a university hospital and were planning surgery. The sample consisted of 106 patients who met the inclusion criteria and agreed to participate in the study. The study’s data was collected using the Personal Information Form, Analgesia Follow-up Form, Surgical Fear Questionnaire, Surgical Anxiety Questionnaire, and Visual Analog Scale prepared in line with the literature. Descriptive statistics, Pearson correlation coefficient, and linear regression analysis were used to evaluate the data.

FINDINGS: A positive linear relationship was found between postoperative pain and surgical anxiety, surgical fear, and preoperative pain (P < .05). Regression analysis revealed that preoperative pain (P = .006) affected the level of postoperative pain. In addition, fear of surgery (P = .035) and postoperative pain (P = .000) were found to affect the use of postoperative 24-hour analgesia.

CONCLUSIONS: The study revealed a relationship between the postoperative pain experienced by the patients and preoperative pain, fear, and anxiety.

PMID:37921714 | DOI:10.1016/j.jopan.2023.07.013

Hepatol Res. 2023 Nov 3. doi: 10.1111/hepr.13981. Online ahead of print.

ABSTRACT

AIM: Following the coronavirus outbreak, a state of public emergency was declared worldwide, which enforced lifestyle changes. This study therefore aimed to investigate the changes in lifestyle, body composition, hepatic steatosis and fibrosis in patients with chronic liver disease (CLD) under lockdown.

METHODS: During the lockdown period, 1344 patients with CLD answered a lifestyle questionnaire. In 298 patients, body composition and liver stiffness measure (LSM) / controlled attenuation parameter (CAP) were analyzed by InBody® and FibroScan®, respectively, and serial data were obtained in 137 patients.

RESULTS: Above half of the CLD patients answered decreases in physical activity and frequency of outings during lockdown, while diet was less affected. Overall, 58% of patients showed elevations in CAP values, which were not different statistically over times. Women, but not men, were more likely to increase CAP values during lockdown. LSM, nor serum fibrosis markers, were not elevated chronologically during lockdown. In men, body mass index (BMI), body fat percentage, and visceral fat area (VFA) were significantly increased, whereas in women, lower-limb muscle mass was significantly decreased. Patients with decreased SMI showed elevations in CAP and VFA values, and patients who exercised less showed increases in BMI.

CONCLUSION: In response to lockdown, men tended to increase body fat but the degree of hepatic steatosis was less affected, while women were more likely to exacerbate hepatic steatosis with skeletal muscle loss among CLD patients. Gender-specific approaches need to be established for management of CLD patients to avoid exacerbation or comorbidity of steatotic liver disease. This article is protected by copyright. All rights reserved.

PMID:37921697 | DOI:10.1111/hepr.13981

Int J Prosthodont. 2023 Nov 1;36(5):649. doi: 10.11607/ijp.7235.

ABSTRACT

PURPOSE: To compare the CIE L*a*b* values of two different dental shade guides using two shade-matching spectrophotometers.

MATERIALS AND METHODS: SpectroShade Micro (SS) and Easyshade (ES) (VITA Zahnfabrik) were tested. One calibrated operator performed 30 measurements of each tab from three batches of the two guides, VITA Classical (VC) and VITA 3D Shade Master (VM). Receiver operating characteristic (ROC) curves and intraclass coefficients (ICC) between the different batches were calculated. Results were given as mean and SD of the L*a*b* values and the respective color differences according to the CIEDE 2000 formula (ΔE00) for each of the shade tabs in the two spectrophotometers and then analyzed with independent student t test (α = .05).

RESULTS: A total of 1,440 and 2,610 measurements for VC and VM, respectively, were performed per spectrophotometer. There were statistically significant differences between the two devices for all L*a*b* values, with the exception of: L* for 3R1.5; a* for 2R1.5, 3L1.5, 2L2.5, 3M2, 3L2.5, 4L1.5, and 4L2.5; and b* for D3, 1M2, and 3M2. When assessing the same shade guide, differences in ΔE00 were detected between devices above the acceptability threshold (AT) (ΔE00 ≥ 1.8) for all shade tabs except for VC (C1, C2, D3, A3.5, C3, and A4) and VM (4M1, 3R2.5, 4L2.5, and 4M3). The overall mean of the interdevice ΔE00 was 2.2 ± 1.0 for VC and 2.5 ± 1.0 for VM.

CONCLUSIONS: The two dental spectrophotometers presented high ICC and ROC values, which validates their indication as auxiliary tools. However, there are discrepancies in the hues D (VC) and R (VM) with interdevice variability when evaluated for the L*a*b* component. Int J Prosthodont 2023;36:e38-e52.

PMID:37921676 | DOI:10.11607/ijp.7235