Nevin Manimala

Ann Behav Med. 2023 Oct 19:kaad060. doi: 10.1093/abm/kaad060. Online ahead of print.

ABSTRACT

BACKGROUND: Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease.

PURPOSE: This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes.

METHODS: Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life’s Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition.

RESULTS: In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p = .004); clients in control pantries had worsened Saturated Fat subcomponents scores (p = .019) and improved physical activity scores (p = .007).

CONCLUSIONS: The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population.

PMID:37857305 | DOI:10.1093/abm/kaad060

Prim Care Companion CNS Disord. 2023 Oct 19;25(5):23m03555. doi: 10.4088/PCC.23m03555.

ABSTRACT

Objective: To assess the efficacy, safety, and tolerability of topiramate for the treatment of posttraumatic stress disorder (PTSD) in civilians.

Methods: This 12-week double-blind, randomized, placebo-controlled study enrolled 72 outpatients (aged 19-64 years) with a DSM-IV-TR diagnosis of non-combat-related PTSD and a score ≥ 50 on the Clinician-Administered PTSD Scale (CAPS). The primary efficacy endpoint, percent change in total CAPS score, and secondary efficacy measures were assessed by analysis of covariance. Safety assessments included monitoring of vital signs, physical examinations, clinical laboratory parameters, electrocardiograms, and adverse events (AEs). The study was conducted from October 2001 to March 2004.

Results: The intent-to-treat (ITT) population (N = 68; mean age = 35 years; 87% women; 74% White) showed greater percent reduction in total CAPS scores with topiramate versus placebo (39.5% vs 29.5%), but the difference was not statistically significant (P = .31). Similarly, higher reductions with topiramate versus placebo were seen in the CAPS subscale scores for symptoms of reexperiencing (43.6% vs 34.8%), avoidance/numbing (38.3% vs 30.6%), and hyperarousal (36.6% vs 21.4%). However, these differences were not statistically significant. Six patients in the topiramate arm had a final CAPS score < 20, whereas only 2 in the placebo arm achieved the result (P = .075). The median final topiramate daily dose was 100 mg/d (range, 25-400 mg/d), and mean ± SD treatment duration was 55 ± 32 days, showing the tolerability of the medication. In topiramate-treated patients, treatment-emergent AEs included paresthesia, headache, fatigue, and insomnia; treatment-limiting AEs included influenza-like symptoms, agitation, cognitive problems not otherwise specified, and somnolence. However, a higher rate of AE-related discontinuation was seen in the placebo group than in the treatment group (26% vs 18%).

Conclusions: In this 12-week civilian PTSD study, topiramate improved the primary and secondary outcome measures at a higher rate than did placebo, but the difference did not reach statistical significance. Further adequately powered studies may be warranted.

Trial Registration: Clinical Trials.gov identifier: NCT00208130.

Prim Care Companion CNS Disord 2023;25(5):23m03555.

Author affiliations are listed at the end of this article.

PMID:37857291 | DOI:10.4088/PCC.23m03555

Oncol Res Treat. 2023 Oct 19. doi: 10.1159/000534674. Online ahead of print.

ABSTRACT

INTRODUCTION: Owing to its low incidence, there no reliable statistics about prognostication derived from large sample sizes have been reported of malignant ovarian germ cell tumors (MOGCTs) and sex cord-stromal tumors (SCSTs). The present study aimed to investigate the clinicopathological prognostic factors and the survival trends of MOGCTs and SCSTs.

MATERIALS AND METHODS: Patients with MOGCTs and SCSTs were recorded in the Surveillance, Epidemiology, and End Results (SEER) database diagnosed between 2000 and 2019. Clinical, demographic, and treatment characteristics were compared between groups of MOGCTs and SCSTs. Cox risk regression analysis and Kaplan-Meier survival curves were used to compare overall survival (OS) and cancer-specific survival (CSS), and to assess the prognostic factors.

RESULTS: Information of 2506 patients with MOGCTs and 1556 patients with SCSTs was extracted from the SEER database, respectively. Aged <40 years and single were more common in patients with MOGCTs than in those with SCSTs. The vast majority of patients with MOGCTs and SCSTs underwent surgery (98.1% vs. 94.5%; P<0.001) and women with MOGCTs were more likely to receive chemotherapy than women with SCSTs (56.1% vs. 32.2%; P<0.001). For both patients before and after propensity-score matching, the 5-year OS rates of patients with SCSTs were lower than that of patients with MOGCTs (P<0.05). In multivariate Cox regression analysis, both age and surgery were independent predictors of OS in patients with MOGCTs and SCSTs. FIGO staging was an independent predictor of CSS in MOGCT patients. Tumor size and chemotherapy were also independent predictors of CSS in patients with SCSTs.

CONCLUSION: Compared to patients with SCSTs, those with MOGCTs tended to be younger and had a higher OS and CSS. Adjuvant chemotherapy after surgery did not prolong OS and CSS in patients with SCSTs.

PMID:37857263 | DOI:10.1159/000534674

Soc Sci Med. 2023 Oct 6;337:116281. doi: 10.1016/j.socscimed.2023.116281. Online ahead of print.

ABSTRACT

The rise of the platform economy during the Covid-19 pandemic has stimulated extensive discussions about whether gig workers can obtain equivalent mental health benefits of regular paid employment. Drawing on nationally representative data in the UK, this study aims to examine (1) whether transitioning from no paid work to gig work during Covid-19 is associated with better or worse mental health compared with those who remained not employed and those who became employed in regular jobs; (2) what mechanisms can explain the mental health differences; (3) how the patterns may differ by gender. The results show that transition into gig work is associated with better mental health compared with those who remained not employed, but this pattern is only for male (rather than female) gig workers and can be largely explained by their better financial situation and lower level of loneliness. For both men and women, the transition into gig work is associated with worse mental health compared with the transition into regular employment, but the mechanisms vary across genders. For male gig workers, both higher levels of financial precarity and loneliness in gig work can explain their mental health disadvantages compared with regular workers, but for female gig workers, none of them is at work. These findings facilitate a better understanding of the health consequences of the gig economy, revealing important gender-differentiated socio-psychological mechanisms through which gig work shapes mental health.

PMID:37857244 | DOI:10.1016/j.socscimed.2023.116281

Soc Sci Med. 2023 Oct 7;337:116298. doi: 10.1016/j.socscimed.2023.116298. Online ahead of print.

ABSTRACT

OBJECTIVE: This study examined several factors affecting the perception of Canadian parents about their children’s mental health during COVID-19. The contribution of this research included fresh evidence from examining the demographic and sociological factors influencing children’s well-being during COVID-19 using the Canadian context.

METHODS: We used a cross-sectional dataset from Statistics Canada titled Impacts of COVID-19 on Canadians – Parenting during the Pandemic (2020). We relied on an ordered logit model and computed the respective odds ratios.

RESULTS: Our results showed that parents with a university degree and those working from home are less concerned about their children’s mental health. Nonetheless, having a disabled child, belonging to a minority, having children aged six-to fourteen-years old, and having lost a job or experienced a drop in working hours increased parents’ worry. Additionally, having worries about being connected with family and friends, being concerned about work-life balance, feeling lonely at home, and waiting for the reopening of childcare services all increased the likelihood of parents’ anxiety about their child’s mental health. When running the analysis by province, we saw that being an immigrant and belonging to a minority increased parents’ worry only in Ontario and British Columbia.

CONCLUSIONS: Policymakers are encouraged to foster working-from-home practices as working from home has been linked to less worry about child mental health, mainly among mothers, as indicated in our gender heterogeneity analysis. In addition, it is advised that families with a disabled child, and families belonging to a minority received additional support. Lastly, policymakers are advised to consider the social cost of preventive measures and incorporate this into any future preventative policymaking as the social impact variables were robust across all models.

PMID:37857242 | DOI:10.1016/j.socscimed.2023.116298

Obstet Gynecol. 2023 Nov 1;142(5):1162-1168. doi: 10.1097/AOG.0000000000005315. Epub 2023 Aug 10.

ABSTRACT

OBJECTIVE: To evaluate access to prenatal care for pregnant patients receiving medication for opioid use disorder (MOUD) under Medicaid coverage in Florida.

METHODS: A cross-sectional, secret shopper study was conducted in which calls were made to randomly selected obstetric clinicians’ offices in Florida. Callers posed as a 14-week-pregnant patient with Medicaid insurance who was receiving MOUD from another physician and requested to schedule a first-time prenatal care appointment. Descriptive statistics were used to report our primary outcome, the callers’ success in obtaining appointments from Medicaid-enrolled physicians’ offices. Wait time for appointments and reasons the physician offices refused appointments to callers were collected.

RESULTS: Overall, 2,816 obstetric clinicians are enrolled in Florida Medicaid. Callers made 1,747 attempts to contact 1,023 randomly selected physicians’ offices from June to September 2021. Only 48.9% of medical offices (n=500) were successfully reached by phone, of which 39.4% (n=197) offered a prenatal care appointment to the caller. The median wait time until the first appointment was 15 days (quartile 1: 7; quartile 3: 26), with a range of 0-55 days. However, despite offering an appointment, 8.6% of the medical offices stated that they do not accept Medicaid insurance payment or would accept only self-pay. Among the 60.6% of callers unable to secure an appointment, the most common reasons were that the clinician was not accepting patients taking methadone (34.7%) or was not accepting any new patients with Medicaid insurance (23.8%) and that the pregnancy would be too advanced by the time of the first available appointment (7.3%).

CONCLUSION: This secret shopper study found that the majority of obstetric clinicians’ offices enrolled in Florida Medicaid do not accept pregnant patients with Medicaid insurance who are taking MOUD. Policy changes are needed to ensure access to adequate prenatal care for patients with opioid use disorder.

PMID:37856854 | DOI:10.1097/AOG.0000000000005315

Altern Ther Health Med. 2023 Oct 20:AT9236. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to assess the current status of early enteral nutrition (EN) support among patients diagnosed with acute pancreatitis (AP) and analyze the factors influencing its duration. The findings aimed to provide guidance for the development of tailored EN support protocols for pancreatitis patients.

METHODS: A convenience sampling method was employed, and 51 patients diagnosed with acute pancreatitis (AP) were enrolled from the Gastroenterology Department of Zhoushan Hospital between May 2020 and June 2021. Data analysis included the categorization of patients based on their early enteral nutrition (EN) support duration, followed by thorough statistical analysis, including logistic regression, to identify the factors impacting EN duration.

RESULTS: The mean duration of early EN support among AP patients was (93.57 ± 43.29) hours. A mere 13.73% of patients initiated EN within 48 hours of admission. Upon categorizing patients by the median duration of EN support, multiple logistic regression analysis revealed several significant risk factors influencing the duration of EN in AP patients, including patient age, underlying medical conditions, severity of pancreatitis, nutritional status, and blood lipase levels (P < .05).

CONCLUSION: The study highlights the significant influence of disease severity and patients’ functional status on the duration of early EN support in AP cases. It emphasizes the importance of a comprehensive patient assessment by medical professionals to determine the optimal timing for initiating EN support.

PMID:37856815

Altern Ther Health Med. 2023 Oct 20:AT8949. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the impact of nursing interventions targeting vital signs and complication risk on perioperative outcomes and complications in patients diagnosed with aortic dissection.

METHODS: This retrospective study included patients presenting to our emergency department with acute chest pain as the primary complaint. Inclusion criteria encompassed identifiable chest pain symptoms, documented occurrence time and a time from symptom onset to blood collection of ≤ 24 hours. The cases of aortic dissection were selected from April 2018 to April 2022 and were diagnosed as major arterial dissection based on the Chinese Expert Consensus on the Criteria for the Diagnosis and Treatment of Aortic Dissection. The control group received conventional nursing care for aortic dissection, while the observation group received a nursing plan incorporating vital signs monitoring and addressing complication risk in addition to standard care.

RESULTS: All 120 enrolled patients successfully recovered and were discharged from the hospital. Age, body weight, operation time, anesthesia time, preoperative albumin levels, hypersensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6) showed no statistically significant differences between the two groups (P > .05). However, 24 hours post-operation, the observation group exhibited significantly lower IL-6 levels compared to the control group (P < .001), with no significant differences in hs-CRP levels (P > .05). Postoperative albumin levels in both aortic dissection groups significantly decreased compared to pre-surgery levels (P < .001) without statistical group differences (P > .05). Compared to controls, the observation group had reduced intraoperative sufentanil dosage, postoperative tracheal catheter extubation time, hospital stay, and costs (P < .001). No anastomotic complications occurred, and edema incidence was lower in the observation group (P = .021), with no significant differences in other complications (P > .05).

CONCLUSIONS: Nursing interventions improve aortic dissection patient outcomes, reduce complications, and warrant broader clinical use.

PMID:37856814

Altern Ther Health Med. 2023 Oct 20:AT9323. Online ahead of print.

ABSTRACT

The purpose of this paper was to construct a prognostic model, miRNA-mRNA regulatory network and protein-protein interaction (PPI) network for lung squamous cell carcinoma (LUSC) used data from the cancer genome atlas (TCGA) database. In this study, we first downloaded and sorted out the expression matrix containing 19962 mRNA transcripts (including 502 LUSC and 51 normal control (NC) samples) and the expression matrix containing 2205 miRNA transcripts (including 478 LUSC and 45 NC samples) from the TCGA database. We obtained 389 differentially expressed miRNAs (DE-miRNAs), of which 305 were upregulated and 84 down-regulated DE-miRNAs. Next, a total of 7 prognosis-related DE-miRNAs (PDE-miRNAs) were identified by Cox regression analysis, and the prognosis model consisting of three PDE-miRNAs (hsa-miR-4746-5p, hsa-miR-556-3p and hsa-miR-489-3p) was optimized. Then, we drew the survival curves and found that the survival rates of the three PDE-miRNA high and low expression groups and the survival rates of the high-risk and low-risk patients in the prognosis model had significant statistical differences. In addition, the receiver operating characteristics (ROC) curve analysis and independent prognostic analysis confirmed that the prognostic model we built has a relatively accurate ability to predict the grouping and prognosis of LUSC patients. Finally, Cox regression analysis were used to construct the miRNA-mRNA regulatory network, which showed the regulatory relationship between PDE-miRNAs and targeted mRNAs. Moreover, we constructed the PPI network composed of 145 targeted mRNAs and the subnetwork composed of 10 hub-targeted mRNAs (FCGR3A, IL13, CCR2, PPARGC1A, FCGR3B, ACSL1, PLXNA4, LPL, KAT2B and AOC3), which showed the interaction between targeted mRNAs. The above results indicated that the prognosis model we built can predict LUSC patients relatively accurately. The miRNA-mRNA regulatory network and the PPI network of targeted mRNAs illustrated the regulatory mechanisms and interactions between RNAs, which were of certain reference significance for us to further understand the molecular pathogenesis of LUSC and for clinical early diagnosis and treatment.

PMID:37856813

Altern Ther Health Med. 2023 Oct 20:AT8787. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigated the therapeutic effect of laparoscopic surgery combined with the plasma electric cutting knife on patients diagnosed with rectal cancer and its impact on serum inflammatory factors in the bloodstream.

METHODS: The researchers examined the clinical data of 85 patients who underwent laparoscopic low anterior resection for rectal cancer in our hospital from April 2020 to December 2021. The patients comprised two groups: an observation group of 40 cases and a control group of 45 cases. The CD3+, CD4+, CD8+, and CD4+/CD8+ levels in both groups were detected using flow cytometry. The levels of relevant inflammatory factors in serum were measured using an automatic biochemical analyzer. The researchers then compared the perioperative outcomes between the two groups.

RESULTS: The observation group demonstrated significantly shorter duration for the first time passing gas after surgery (P = .029) and hospital stays (P = .002) than the control group. Both groups experienced decreased levels of CD8+ cells following treatment, with the observation group exhibiting lower levels than the control group (P < .05). After three months of treatment, both groups showed reduced levels of relevant serum inflammatory factors, TNF-α, IL-1, IL-6, and IL-8; however, the observation group was significantly lower than the control group with statistical significance (P < .05). Similarly, after three months of treatment, both groups exhibited lower levels of relevant serum electrolytes K+, Na+, and Cl-, with the observation group having lower levels than the control group (P < .05). Throughout the 12-month follow-up period, the two groups had no significant differences (P > .05) in complications such as urinary tract infection, anastomotic leakage, or anastomotic bleeding.

CONCLUSION: Using a combination of laparoscopic techniques and a plasma electric cutting knife proved a highly effective surgical approach in treating rectal cancer. The method has numerous advantages, such as enhanced safety and few complications. When considering perioperative complications, it was evident that laparoscopic combined with the plasma electric cutting knife surpassed other surgical methods in treating rectal cancer.

PMID:37856808