Nevin Manimala

Health Econ. 2022 Oct 31. doi: 10.1002/hec.4626. Online ahead of print.

ABSTRACT

This paper re-examines a well-established hypothesis postulating that life expectancy augments incentives for human capital accumulation, leading to global income differences. A major distinguishing feature of the current study is to estimate heterogeneous panel data models under a common factor framework, which explicitly accounts for parameter heterogeneity, unobserved common factors (UCFs), and variables’ non-stationarity. In sharp contrast to most previous studies, I find that the impact of health improvements on human capital accumulation turns out to be imprecisely estimated at conventionally accepted levels of statistical significance. I demonstrate that conventional estimates of the educational returns to rising longevity are derived from estimating misspecified models at least partially due to parameter heterogeneity and the presence of UCFs.

PMID:36314282 | DOI:10.1002/hec.4626

Ann Pharmacother. 2022 Oct 29:10600280221133577. doi: 10.1177/10600280221133577. Online ahead of print.

ABSTRACT

BACKGROUND: No study has yet systematically evaluated the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with type 2 diabetes (T2D).

OBJECTIVE: We aimed to evaluate the effect of different antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D.

METHODS: We comprehensively retrieved the published research which examined the effect of antidiabetic therapy on clinical outcomes of COVID-19 patients with T2D. The odds ratio (OR) and its 95% confidence interval (95% CI) for clinical outcomes were calculated using the random-effects model, and meta-regression was adopted to evaluate the potential sources of heterogeneity between studies.

RESULTS: A total of 54 studies were included in this study. We found that the use of metformin (OR = 0.66, 95% CI: 0.58-0.75), SGLT-2i (OR = 0.80, 95% CI: 0.73-0.88), and GLP-1ra (OR = 0.83, 95% CI: 0.70-0.98) were significantly associated with lower mortality risk in COVID-19 patients with T2D, while insulin use might unexpectedly increase the ICU admission rate (OR = 2.32, 95% CI: 1.34-4.01) and risk of death (OR = 1.52, 95% CI: 1.32-1.75). No statistically significant associations were identified for DPP-4i, SUs, AGIs, and TZDs.

CONCLUSION AND RELEVANCE: We demonstrated that the usage of metformin, SGLT-2i, and GLP-1ra could significantly decrease mortality in COVID-19 patients with T2D. The heterogeneity across the studies, baseline characteristics of the included patients, shortage of dosage and the duration of antidiabetic drugs and autonomy of drug selection might limit the objectivity and accuracy of results. Further adequately powered and high-quality randomized controlled trials are warranted for conclusive findings.

PMID:36314281 | DOI:10.1177/10600280221133577

Ann Pharmacother. 2022 Oct 29:10600280221132851. doi: 10.1177/10600280221132851. Online ahead of print.

ABSTRACT

BACKGROUND: Opioid-induced constipation (OIC) may occur in up to 81% of critically ill patients and can lead to many complications. Opioid antagonists are a reasonable approach and may be used for managing OIC.

OBJECTIVE: The purpose of this study was to assess the efficacy of enteral naloxone (NLX) versus subcutaneous methylnaltrexone (MNTX) for the management of OIC in critically ill patients.

METHODS: A retrospective analysis was conducted on adult patients who received NLX or MNTX and a continuous opioid infusion for at least 48 hours. The primary end point was time to resolution of constipation, defined as hours to first bowel movement (BM) after the first dose of an opioid antagonist. Reversal of analgesia was assessed by comparing the total number of morphine milligram equivalents (MME) 24 hours preopioid and postopioid antagonist administration. Univariate and multivariate analyses were conducted to assess treatment response within 48 hours.

RESULTS: Baseline characteristics were similar between patients receiving NTX (n = 89) and MNTX (n = 71). However, the time to the first BM with NLX was 18 hours compared with 41 hours with MNTX (P = 0.004). There was no difference in MME requirements 24 hours pre/post NLX or MNTX administration. Naloxone administration was identified as a statistically significant predictor of BM within 48 hours (odds ratio [OR] = 2.68 [1.33-5.38]).

CONCLUSION AND RELEVANCE: The time to first BM was shorter with enteral NLX. Both NLX and MNTX appear to be effective for the management of OIC without causing reversal of analgesia. Future controlled, prospective trials comparing these agents are warranted.

PMID:36314271 | DOI:10.1177/10600280221132851

Diabetes Obes Metab. 2022 Oct 31. doi: 10.1111/dom.14908. Online ahead of print.

ABSTRACT

AIM: To assess the efficacy and safety of liraglutide to reduce visceral and ectopic fat in adults with or without type 2 diabetes mellitus(T2DM).

METHODS: Four databases were searched up to 6 May 2022 for RCTs assessing effect of liraglutide on visceral and ectopic fat. The mean and standard deviation (SD) of the values of visceral fat, ectopic fat, and body mass index (BMI) were calculated. Subgroup analyses were performed based on the type of disease (T2DM or non-T2DM), duration of intervention, dosage of liraglutide, and whether life interventions were added to liraglutide therapy. We extracted and integrated the safety assessments reported in each article.

RESULTS: Sixteen RCTs with a total of 845 participants were included in the meta-analysis. Liraglutide could significantly decrease visceral fat (SMD = -0.72, 95% CI [-1.12, -0.33]), liver fat (SMD = -0.78, 95% CI [-1.24, -0.32]), and BMI (WMD = -1.44, 95% CI [-1.95, -0.92]) in adult patients with or without T2DM when compared to control group. However, reduction of epicardial fat by liraglutide (SMD = -0.74, 95% CI [-1.82,0.34]) was not statistically significant. Subgroup analysis revealed that an adequate dosage (≥1.8 mg/day) and appropriate duration of treatment (ranging from 16 to 40 weeks) were the decisive factors for liraglutide to effectively reduce visceral fat. Mild gastrointestinal reactions were the main adverse event of liraglutide.

CONCLUSIONS: Liraglutide significantly and safely reduces visceral and ectopic liver fat irrespective of T2DM status, and reduces visceral fat provided adequate dosage and duration of therapy are ensured. This article is protected by copyright. All rights reserved.

PMID:36314246 | DOI:10.1111/dom.14908

J Pediatr Rehabil Med. 2022 Oct 22. doi: 10.3233/PRM-210085. Online ahead of print.

ABSTRACT

PURPOSE: The study aimed to examine the effects of “Cognitive Orientation to daily Occupational Performance” (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents’ satisfaction level.

METHODS: Thirty-two children with CP were randomized to experimental (n = 16) or control (n = 16) groups, with n = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT.

RESULTS: No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p < 0.05).

CONCLUSION: CO-OP is expected to be beneficial if incorporated into CP rehabilitation.

PMID:36314226 | DOI:10.3233/PRM-210085

J Neonatal Perinatal Med. 2022 Oct 26. doi: 10.3233/NPM-221068. Online ahead of print.

ABSTRACT

BACKGROUND: Kangaroo mother care (KMC) is defined as prolonged skin to skin care between a mother and infant with the infant lying in prone position on mom’s chest. KMC decreases morbidity and mortality and promotes physiologic stability. The aim of this study is to measure work of breathing (WOB) during KMC in very low birth weight (VLBW) infants on non-invasive respiratory support.

METHODS: A prospective observational pilot study was conducted comparing WOB indices during standard care (SC) and KMC. Respiratory inductive plethysmography (RIP) measured WOB indices non-invasively: phase angle and labored breathing index. VLBW infants who were stable on non-invasive respiratory support were randomized to receive RIP measurements during KMC or during SC first. Summary statistics and mixed linear models were used to compare WOB and vital signs.

RESULTS: A total of 32 infants were consented for the study, data collection and analysis was completed on 28 infants. There were no significant differences in mean phase angle during KMC or SC (73.5±4.6 SE deg vs 66.8±3.9 SE deg, p = 0.25). No differences in WOB and vital signs were detected. Controlling for respiratory support or randomization/first location did not change the results.

CONCLUSION: In this pilot cohort, infants demonstrated no differences in work of breathing indices or oxygen saturation during KMC or SC while receiving non-invasive respiratory support. KMC appears to be safe and well tolerated with no worsened WOB. Larger studies should be performed to confirm our findings.

PMID:36314219 | DOI:10.3233/NPM-221068

J Alzheimers Dis. 2022 Oct 26. doi: 10.3233/JAD-220341. Online ahead of print.

ABSTRACT

BACKGROUND: The BetterBrains Randomized Controlled Trial (RCT) will evaluate the effectiveness of an online, person-centered, risk factor management, coaching intervention in community-dwelling, healthy adults at risk of cognitive decline. Multi-component interventions are challenging to evaluate due to program complexity and personalization to individual needs and contexts. This paper describes a multi-level process evaluation conducted alongside the BetterBrains RCT.

OBJECTIVE: To understand how and why the BetterBrains intervention was effective or ineffective at reducing cognitive decline in healthy adults whilst considering the context in which it was implemented.

METHODS: 1,510 non cognitively-deteriorated community-dwelling adults aged 40-70 years old at risk of cognitive decline will be recruited and randomly assigned to the intervention or control group. All BetterBrains intervention participants, coaches, and the research team will be included in the evaluation. A mixed-methods design will be used, guided by The Framework for Implementation Fidelity and the program logic model. Data will be sourced from interviews, focus groups, surveys, BetterBrains coach notes, participant weekly check-in surveys, and audio recordings of intervention coaching sessions. Quantitative data will be analyzed via descriptive and inferential statistics and qualitative data will be analyzed using content and thematic analysis.

RESULTS: The process evaluation will provide information about contextual and influencing factors related to the implementation of BetterBrains and the RCT outcomes.

CONCLUSION: Understanding how BetterBrains was implemented and its associated impacts will inform the translation of the program into community and clinical settings, providing easy access to online, personalized dementia prevention services.

PMID:36314199 | DOI:10.3233/JAD-220341

ACR Open Rheumatol. 2022 Oct 31. doi: 10.1002/acr2.11507. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this cross-sectional study was to investigate the impact of the COVID-19 pandemic on physical activity (PA) levels of patients with rheumatic and musculoskeletal diseases (RMDs) and to examine factors associated with decreased PA.

METHODS: A sample of adult patients with RMDs (n = 7,776) was identified through electronic medical records from an academic health care system in North Carolina. Invitations to participate in an online survey were sent between July 2020 and September 2020 to assess self-reported changes in PA during the COVID-19 pandemic. Descriptive statistics, age-adjusted prevalence odds ratios (PORs), and 95% confidence intervals (CIs) were computed to examine patient characteristics associated with decreased PA.

RESULTS: A total of 893 eligible participants completed the survey (mean age 57.8 ± 14.9 years, 75.8% female). The most common primary diagnoses reported among participants included rheumatoid arthritis (27.3%), osteoarthritis (16.0%), and systemic lupus erythematosus (SLE) (13.0%). More than half of participants (56.8%) reported engaging in less PA since the pandemic began. Factors associated with engaging in less PA included lower self-reported general health (POR, 2.21; CI, 1.64-2.97) and a diagnosis of SLE (POR, 1.57; CI, 1.03-2.38). Comorbidities associated with decreased PA included chronic pain (POR, 1.38; CI, 1.04-1.82), depression (POR, 1.48; CI, 1.09-2.01), and hypertension (POR, 1.44; CI, 1.10-1.90).

CONCLUSION: The COVID-19 pandemic has exacerbated barriers to PA in patients with RMDs. There is a critical need to provide resources, support, and multifaceted programs to encourage PA in patients with RMDs during the COVID-19 pandemic.

PMID:36314195 | DOI:10.1002/acr2.11507

Technol Health Care. 2022 Oct 18. doi: 10.3233/THC-220462. Online ahead of print.

ABSTRACT

BACKGROUND: Foot drop is one of the most common complications after stroke.

OBJECTIVE: This study investigates the role of an adjustable medical foot support pillow in preventing foot drop and improving the lower limb function of patients after stroke.

METHODS: A total of 88 patients with strokes admitted to our hospital from September 2019 to September 2020 were selected and categorised into the control (n= 44) and intervention groups (n= 44) using a random number table. The control group received routine rehabilitation nursing, while the intervention group adopted a self-made adjustable medical foot support pillow based on routine rehabilitation nursing. After four weeks, the simplified Fugl Meyer Assessment (FMA) and the modified activities of daily living (ADL) scales were used to measure the ankle range of motion of the lower limbs. The lower limb motor function, ADL, and ankle mobility before and after treatment, as well as the incidence of foot ptosis, were compared between the two groups.

RESULTS: After the procedure, the intervention group was superior to the control group in the FMA score of the lower extremities, ADL score, and ankle joint mobility in the lower limbs, indicating statistically significant differences (P< 0.05). The incidence rate of foot drop was lower in the intervention group than in the control group, and the difference was statistically significant (P< 0.05).

CONCLUSION: The adjustable medical foot support pillow can prevent foot drop in patients after stroke, improve lower limb function, provide a favourable basis for walking training, and improve the ADL of patients.

PMID:36314179 | DOI:10.3233/THC-220462

J Obstet Gynaecol Res. 2022 Oct 30. doi: 10.1111/jog.15482. Online ahead of print.

ABSTRACT

AIM: This retrospective study aimed to investigate the value of exome sequencing (ES) in fetuses with isolated first-trimester increased nuchal translucency (NT) and normal chromosomes.

METHODS: ES was performed on 103 fetuses with isolated first trimester increased NT and normal chromosomes. The detection rate of monogenic conditions was analyzed.

RESULTS: Diagnostic variants were detected in nine cases in which phenotypes and genotypes correlated well, two positive cases were Thanatophoric dysplasia type I, and one case was Kabuki syndrome, which had been detected in previous studies. Eight of the nine cases with diagnostic variants developed additional structural malformations later in pregnancy. Among the nine positive cases, six had a NT thickness between 95th percentile (95th-3.4 mm), and three cases with an increased NT of 3.5 mm or greater. Also, there was no statistical difference in the diagnosis of diagnostic variants in cases with or without a thickened nuchal fold (NF).

CONCLUSIONS: The diagnostic yield of prenatal ES is low for fetuses with an isolated increased NT. In addition to Noonan syndrome, there are additional genetic syndromes such as Kabuki syndrome and Thanatophoric dysplasia type I that are potentially associated with an increased NT. A cut-off of greater than the 95th percentile may be useful in case selection for ES. Whether it is clinically meaningful to monitor NF values for fetuses with isolated increased NT and normal chromosomes worth considering.

PMID:36310088 | DOI:10.1111/jog.15482