Nevin Manimala

JAMA Netw Open. 2023 Mar 1;6(3):e233684. doi: 10.1001/jamanetworkopen.2023.3684.

ABSTRACT

IMPORTANCE: Many states enacted 20-week abortion bans from 2011 to 2018. Such bans affect individuals who receive diagnoses of fetal anomalies and aneuploidy in the second trimester, preventing pregnant individuals from having the choice of whether or not to continue the pregnancy.

OBJECTIVES: To examine the trends of neonatal Down syndrome rates and assess the association between enactment of 20-week abortion bans and rates of Down syndrome diagnosis.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, historical cohort study used National Vital Statistics System data on 31 157 506 births in the US from 2011 to 2018. Statistical analysis was performed from May 2021 to February 2023.

EXPOSURE: States were categorized as those with or without a 20-week abortion ban enacted during the study period.

MAIN OUTCOMES AND MEASURES: Demographic characteristics between the ban and no-ban states were compared using χ2 tests and 2-sample t tests. Multivariable logistic regression evaluated the adjusted odds of Down syndrome among births in states that enacted 20-week abortion bans after the abortion ban enactment, adjusting for state, year of birth, maternal race and ethnicity, age, educational level, insurance, and number of prenatal visits.

RESULTS: The cohort consisted of 31 157 506 births (mean [SD] maternal age, 28.4 [5.9] years) in the United States, of whom 15 951 neonates (0.05%) received a diagnosis of Down syndrome at birth. A total of 17 states enacted 20-week abortion bans during the study period, and 33 states did not enact bans. In both states with and states without bans, the birth prevalence of neonatal Down syndrome increased over time; in states with bans, rates increased from 48.0 to 58.4 per 100 000 births; in states without bans, rates increased from 47.4 to 53.3 per 100 000 births. In multivariable logistic regression assessing the interaction of time and presence of a 20-week abortion ban, the odds of Down syndrome were higher in states that enacted 20-week abortion bans after enactment of the law compared with the years prior to enactment of the ban (adjusted odds ratio, 1.22; 95% CI, 1.11-1.35).

CONCLUSIONS AND RELEVANCE: In the US from 2011 to 2018, neonatal Down syndrome diagnoses increased more in states that enacted 20-week abortion bans compared with states that did not enact bans. Because these abortion bans were enacted throughout the study period and are known to inhibit choice in patient decision-making, it is possible that the difference in the rates of diagnosis is associated with these policies.

PMID:36943268 | DOI:10.1001/jamanetworkopen.2023.3684

Pain. 2023 Mar 22. doi: 10.1097/j.pain.0000000000002894. Online ahead of print.

ABSTRACT

Individuals respond differently to inflammation. Pain, sadness, and fatigue are common correlates of inflammation among breast cancer survivors. Stress may predict response intensity. This study tested whether breast cancer survivors with greater exposure to acute or chronic social or nonsocial stress had larger increases in pain, sadness, and fatigue during an acute inflammatory response. In total, 156 postmenopausal breast cancer survivors (ages 36-78 years, stage I-IIIA, 1-9 years posttreatment) were randomized to either a typhoid vaccine/saline placebo or the placebo/vaccine sequence, which they received at 2 separate visits at least 1 month apart. Survivors had their blood drawn every 90 minutes for the next 8 hours postinjection to assess levels of interleukin-6 and interleukin-1 receptor antagonist (IL-1Ra). Shortly after each blood draw, they rated their current levels of pain, sadness, and fatigue. Women also completed the Test of Negative Social Exchange to assess chronic social stress and the Trier Inventory of Chronic Stressors screen to index chronic general stress. At each visit, a trained experimenter administered the Daily Inventory of Stressful Events to assess social and nonsocial stress exposure within the past 24 hours. After statistical adjustment for relevant demographic and behavioral covariates, the most consistent results were that survivors who reported more chronic social stress reported more pain and sadness in response to IL-1Ra increases. Frequent and ongoing social stress may sensitize the nervous system to the effects of inflammation, with potential implications for chronic pain and depression risk among breast cancer survivors.

PMID:36943254 | DOI:10.1097/j.pain.0000000000002894

J Magn Reson Imaging. 2023 Mar 21. doi: 10.1002/jmri.28684. Online ahead of print.

ABSTRACT

BACKGROUND: Intravoxel incoherent motion (IVIM) MRI has not been widely used and its role in evaluating exertional heat illness (EHI)-related myocardial involvement remains unknown.

PURPOSE: To investigate the feasibility of strain curve-derived trigger delay (TD) IVIM-MRI and its role in assessing myocardial diffusion and microvascular perfusion of EHI patients.

STUDY TYPE: Prospective.

SUBJECTS: A total of 42 male EHI patients (median age: 21 years) and 22 age- and sex-matched healthy controls (HC).

FIELD STRENGTH/SEQUENCE: A 3-T, diffusion-weighted spin-echo echo-planar-imaging sequence.

ASSESSMENT: IVIM-MRI was acquired by conventional TD method (group A) or strain curve-based TD method (group B) in random order. IVIM image quality was evaluated on a 3-point Likert scale (1, nondiagnostic; 2, moderate; 3, good). Technical success was defined as image quality score = 3. IVIM-MRI-derived parameters (pseudo diffusion in the capillaries [D*], perfusion fraction [f], and slow apparent diffusion coefficient [D]) were compared between EHI and HC.

STATISTICAL TESTS: Student’s t-tests, chi-square tests, one-way analysis of variance, receiver operating characteristic (ROC) curve analysis, Pearson’s correlation coefficient (r). The statistical significance level was set at P < 0.05.

RESULTS: IVIM-MRI image quality score (median [interquartile range]: 3 [2, 3] vs. 2 [1-3]) and technical success rate (61.9%[13/21] vs. 28.6%[6/21]) were significantly improved in group B. EHI patients showed significantly decreased D* (118.1 ± 23.3 × 10^-3 mm² /sec vs. 142.7 ± 42.6 × 10^-3 mm² /sec) and f values (0.42 ± 0.12 vs. 0.51 ± 0.11) and significantly higher D values (3.0 ± 0.9 × 10^-3 mm² /sec vs. 2.5 ± 0.6 × 10^-3 mm² /sec) compared to HC. Relative to D and D*, f showed the most robust efficacy for detecting EHI-related myocardial injury with the highest area under the ROC curve (0.906: 95% confidence interval, 0.799, 0.967) and sensitivity of 88.5% and specificity of 85.6%.

CONCLUSION: The strain curve-based TD method significantly improved image quality and technical success rate of IVIM-MRI, and f value may be an effective biomarker to assess myocardial microcirculation abnormalities of EHI patients.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 3.

PMID:36943201 | DOI:10.1002/jmri.28684

J Feline Med Surg. 2023 Mar;25(3):1098612X231158582. doi: 10.1177/1098612X231158582.

ABSTRACT

OBJECTIVES: This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

METHODS: In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale – short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05).

RESULTS: The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001).

CONCLUSIONS AND RELEVANCE: This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

PMID:36943182 | DOI:10.1177/1098612X231158582

Public Health Nurs. 2023 Mar 21. doi: 10.1111/phn.13190. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study we aimed to describe and compare groups formed by a rules-based algorithm to prospectively identify clients at risk of poor outcomes in order to guide tailored public health nursing (PHN) intervention approaches.

DESIGN: Data-driven methods using standardized Omaha System PHN documentation.

SAMPLE: Clients ages 13-40 who received PHN home visiting services for both the Caretaking/parenting and Mental health problems (N = 4109).

MEASUREMENT: We applied a theory-based algorithm consisting of six rules using existing Omaha System data. We examined the groups formed by the algorithm using standard descriptive, inferential statistics, and Latent Class Analysis.

RESULTS: Clients (N = 4109) were 25.1 (SD = 5.9) years old and had an average of 7.3 (SD = 3.2) problems, 250 (SD = 319) total interventions, and 32 (SD = 44) Mental health interventions. Overall outcomes improved after PHN interventions (p < .001 for all) and having more Mental health signs/symptoms was negatively associated with outcome scores (p < .001 for all).

CONCLUSIONS: This algorithm may be helpful in identifying high-risk clients during a baseline assessment who may benefit from more intensive mental health interventions. Findings show there is value using the Omaha System for PHN documentation and algorithm clinical decision support development. Future research should focus on algorithm implementation in PHN clinical practice.

PMID:36943178 | DOI:10.1111/phn.13190

Twin Res Hum Genet. 2023 Mar 21:1-5. doi: 10.1017/thg.2023.9. Online ahead of print.

ABSTRACT

A model in the form of a Markov chain is constructed to mimic variations in the human sex ratio. It is illustrated by simulation. The equilibrium distribution is shown to be a simple modification of the binomial distribution. This enables an easy calculation of the variation in sex ratio which could be expected in small populations.

PMID:36943175 | DOI:10.1017/thg.2023.9

Biotechnol Genet Eng Rev. 2023 Mar 21:1-11. doi: 10.1080/02648725.2023.2191087. Online ahead of print.

ABSTRACT

To investigate the predictive value of acoustic radiation force impulse imaging for neoadjuvant chemotherapy in breast cancer. Seventy-eight breast cancer patients treated in our hospital from March 2019 to March 2022 were recruited. They received neoadjuvant chemotherapy and were examined by conventional ultrasound and acoustic radiation force impulse imaging before chemotherapy and after two cycles of chemotherapy. The lesion diameter, intralesional blood flow pulsatility index (PI), resistance index (RI), shear wave velocity (SWV), and change rate (Δlesion diameter, ΔPI, ΔRI, ΔSWV) were compared between the two groups before and after chemotherapy. The receiver operating characteristic curve was drawn to evaluate the predictive power of related parameters on the efficacy of neoadjuvant chemotherapy in breast cancer. After two cycles of neoadjuvant chemotherapy, according to the Miller-Payne grading, 57 cases (73.08%) with significant neoadjuvant chemotherapy response were classified as the response group, and 21 cases (26.92%) with non-significant response were classified as the non-response group. Before and after chemotherapy, the difference in lesion diameter, PI, RI, SWV, and change rate (Δlesion diameter, ΔPI, ΔRI, and ΔSWV) was statistically significant between the two groups (P < 0.05). The area under the curve of ΔSWV in predicting the efficacy of neoadjuvant chemotherapy 0.876 (95%CI 0.781 ~ 0.939) was significantly higher than that of Δlesion diameter 0.652 (95%CI 0.535 ~ 0.756), that of ΔPI 0.712 (95%CI 0.599 ~ 0.809), and that of ΔRI 0.678 (95%CI 0.563 ~ 0.780) (P < 0.05). The change rate of tissue stiffness has a relatively high predictive value for the effect of neoadjuvant chemotherapy in breast cancer.

PMID:36943110 | DOI:10.1080/02648725.2023.2191087

United European Gastroenterol J. 2023 Mar 21. doi: 10.1002/ueg2.12367. Online ahead of print.

ABSTRACT

BACKGROUND: The management of postoperative recurrence (POR) in Crohn’s disease (CD) after ileo-colonic resection is a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in the presence of at least one clinical risk factor.

OBJECTIVE: Our aim was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only one risk factor.

METHODS: CD patients with only one risk factor for POR, including previous intestinal resection, extensive small intestine resection (>50 cm), fistulising phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery (“prophylaxis group”) or guided by endoscopy (“endoscopy-driven group”). Primary endpoints were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery.

RESULTS: A total of 195 patients were enroled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy-driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe endoscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively).

CONCLUSIONS: In operated CD patients with only one risk factor for POR, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm our results.

PMID:36942657 | DOI:10.1002/ueg2.12367

AIDS Care. 2023 Mar 21:1-8. doi: 10.1080/09540121.2023.2189224. Online ahead of print.

ABSTRACT

Characterizing spatial distribution of HIV outcomes is vital for targeting interventions to areas most at risk. We performed spatial analysis to identify geographic clusters and factors associated with mortality in KwaZulu-Natal, South Africa. We utilized Sizanani trial (NCT01188941) data, which enrolled participants August 2010-January 2013 and obtained vital status at 5.8 (IQR 5.0-6.4) years of follow-up. We mapped geocoded addresses to 2011 Census-defined small area layer (SAL) centroids, used Kulldorff’s spatial scan statistic to identify mortality clusters, and compared socio-demographic factors for SALs within and outside mortality clusters. We assigned 1,143 participants living with HIV (260 [23%] of whom died during follow-up) to 677 SALs. One lower mortality cluster (n = 90, RR = 0.23, p = 0.022) was identified near a hospital outside Durban. SALs in the cluster were younger (24y vs 25y, p < 0.001); had fewer bedrooms/household (3 vs 4, p < 0.001); had more females (52% vs 51%, p = 0.013) and residents with no schooling past age 20 (4% vs 3%, p < 0.001) or no education at all (4% vs 3%, p < 0.001); had fewer residents with income >3,200 ZAR/month (5% vs 9%, p < 0.001); and had reduced access to piped water (p < 0.001), refuse disposal (p < 0.001), and toilets (p < 0.001). Targeted interventions may improve outcomes in areas with similar characteristics.

PMID:36942651 | DOI:10.1080/09540121.2023.2189224

Adv Life Course Res. 2023 Mar;55:100527. doi: 10.1016/j.alcr.2023.100527. Epub 2023 Jan 18.

ABSTRACT

The increase in cohabitation and nonmarital childbearing across Europe has raised questions about who still marries either before or after having a child. Although prior studies have addressed the sequence of marriage and childbearing, few have examined the role of relationship quality in these transitions. Here we employ a cross-national perspective to study the association between relationship quality and marriage and/or first birth within cohabitation. Using the Generations and Gender Survey and UK Household Longitudinal Study, we study seven European countries (Austria, France, Hungary, Netherlands, Norway, Sweden, and UK). We employ competing risk hazard models to follow respondents as they 1) transition from cohabitation into marriage or conception (or separation); 2) transition to marriage (or separation) after having a birth within cohabitation. Results show that cohabitors with higher relationship quality are more marriage prone than those in lower quality relationships in Austria, France, Hungary, and the UK, but not in the Netherlands, Norway and Sweden. Instead, higher relationship quality is associated with higher conception risks in cohabitation in Sweden. After childbearing, we find a positive association between relationship quality and marriage among cohabiting parents in the Netherlands, Norway, Sweden, and the United Kingdom. These results suggest that marriage is still important for couples with higher quality relationships; however, in countries where cohabitation is widespread, the timing of marriage may have shifted to after childbearing.

PMID:36942640 | DOI:10.1016/j.alcr.2023.100527