Nevin Manimala

J Am Med Dir Assoc. 2022 Jan 14:S1525-8610(21)01104-X. doi: 10.1016/j.jamda.2021.12.030. Online ahead of print.

ABSTRACT

OBJECTIVE: To test the effect of a personalized music intervention on agitated behaviors and medication use among long-stay nursing home residents with dementia.

DESIGN: Pragmatic, cluster-randomized controlled trial of a personalized music intervention. Staff in intervention facilities identified residents’ early music preferences and offered music at early signs of agitation or when disruptive behaviors typically occur. Usual care in control facilities may include ambient or group music.

SETTING AND PARTICIPANTS: The study was conducted between June 2019 and February 2020 at 54 nursing homes (27 intervention and 27 control) in 10 states owned by 4 corporations.

METHODS: Four-month outcomes were measured for each resident. The primary outcome was frequency of agitated behaviors using the Cohen-Mansfield Agitation Inventory. Secondary outcomes included frequency of agitated behaviors reported in the Minimum Data Set and the proportion of residents using antipsychotic, antidepressant, or antianxiety medications.

RESULTS: The study included 976 residents with dementia [483 treatment and 493 control; mean age = 80.3 years (SD 12.3), 69% female, 25% African American]. CMAI scores were not significantly different (treatment: 50.67, SE 1.94; control: 49.34, SE 1.68) [average marginal effect (AME) 1.33, SE 1.38, 95% CI -1.37 to 4.03]. Minimum Data Set-based behavior scores were also not significantly different (treatment: 0.35, SE 0.13; control: 0.46, SE 0.11) (AME -0.11, SE 0.10, 95% CI -0.30 to 0.08). Fewer residents in intervention facilities used antipsychotics in the past week compared with controls (treatment: 26.2, SE 1.4; control: 29.6, SE 1.3) (AME -3.61, SE 1.85, 95% CI -7.22 to 0.00), but neither this nor other measures of psychotropic drug use were statistically significant.

CONCLUSIONS AND IMPLICATIONS: Personalized music was not significantly effective in reducing agitated behaviors or psychotropic drug use among long-stay residents with dementia. Barriers to full implementation included engaging frontline nursing staff and identifying resident’s preferred music.

PMID:35038407 | DOI:10.1016/j.jamda.2021.12.030

Colorectal Dis. 2022 Jan 17. doi: 10.1111/codi.16054. Online ahead of print.

ABSTRACT

AIM: To determine safety of performing an anastomosis after rectal cancer (RC) resection in patients with a previously treated prostate cancer (PC).

METHODS: Patients with a previously treated PC who underwent rectal resection from 2008 to 2018 were retrospectively included. Outcomes were compared between patients who underwent rectal resection with anastomosis (restorative surgery, RS+ group) and those with a definitive stoma (RS- group). In the RS+ group, anastomotic leak (AL) rates were assessed according to the type of reconstruction.

RESULTS: 126 patients underwent rectal surgery for mid-low RC after a previously PC treated by RT and/or radical prostatectomy. Overall, 80 patients (63%) underwent a RS and 46 patients (37%) underwent rectal surgery with a definitive stoma. There was no statistical difference between the two groups in terms of intraoperative data, except for the type of resection with more multivisceral resection in the RS- group (p<0.01). In the RS+ group, a diverting stoma was performed in 74% of cases. No difference between the two groups in terms of overall morbidity was found. In the RS+ group (n=80), 17 patients (21%) experienced AL. Of these none was observed when delayed coloanal anastomosis was performed (p=0.16). Long-term permanent stoma in the RS+ group was 16% (n=13).

CONCLUSION: Restorative surgery after resection for RC in patients with a previous history of RT and/or radical prostatectomy for PC is safe without additional morbidity. In selected patients for restorative surgery, performing delayed coloanal anastomosis may represent a promising option.

PMID:35038368 | DOI:10.1111/codi.16054

J Clin Endocrinol Metab. 2022 Jan 17:dgac021. doi: 10.1210/clinem/dgac021. Online ahead of print.

ABSTRACT

PROPOSE: Obesity-related metabolic risk factors in adolescents with overweight/obesity may be associated with systemic low-grade inflammation, and therefore we investigated whether a 6-month exercise training altered markers of inflammation.

METHODS: Secondary analyses of a randomized controlled exercise-based intervention trial (September 2017 to December 2018). Adolescents aged 11 to 17 years (Tanner stage II to V), 70% girls, with a body mass index (BMI) z-score at or above the 85 th percentile, and/or with excess of adiposity (body fat >30%). The participants were randomly assigned to the following 4 groups for 6 months: (1) standard physical education lessons, as a control (CTRL); (2) high-intensity physical education class (HIPE); (3) low-to-moderate intensity physical education class (LIPE); (4) a combined group (PLUS group). Inflammatory markers and immune molecules including chemokines, cytokines, and growth factors (n=65 biomarkers) were determined by cytokine antibody array.

RESULTS: Of the 120 randomly assigned participants, 95 were included in the analysis. Considering these 22 proteins, the LIPE group shows statistical significance in 9 proteins with logfold-change (logFC) and p<0.05 was found in BLC, Eotaxin, FGF-6, GCP-2, I-309, IGFBP-4, MCP-4, NAP-2, and PARC), followed by the PLUS group in 9 proteins (BLC, EGF, Eotaxin, FGF-6, MCP-4, NAP-2, Osteopontin, PARC, and RANTES), the HIPE group in 7-proteins (FGF-4, FGF-7, GCP-2, IGF-1, IGFBP-1, IGFBP-4, and MIP-1 delta), the CTRL group in 6 proteins (FGF-4, IP-10, Leptin, MCP-1, MIG, and MIP-1 delta). However, sub-analysis performed to detect differentially expressed proteins at baseline and post-intervention, with significance at an adjusted p value ≤ 0.05 and absolute (logFC) ≥ 1.0, shown three down-regulated proteins in the LIPE group (BLC (logFC)= 1.27, Eotaxin (logFC)= 1.18 and MCP-4 (logFC)= 1.14), and four proteins in the HIPE group (BLC (logFC)= 1.45, FGF-6 (logFC)= 1.20, MCP-4 (logFC)= 1.50, and PARC ​(logFC)= 1.33), supporting that the changes that we observed in the exercise groups were not time-related changes but occurred in response to exercise.

CONCLUSIONS: Implementing a 6-month physical exercise program in overweight/obese adolescents, based on LIPE and PLUS groups, significantly change several circulating inflammatory levels. Interventions involving supervised physical exercise may reduce the associated effects of systemic low-grade inflammation, thus preventing the development of obesity-related metabolic diseases in adolescents with overweight/obesity.

PMID:35038337 | DOI:10.1210/clinem/dgac021

J Trop Pediatr. 2022 Jan 7;68(1):fmab112. doi: 10.1093/tropej/fmab112.

ABSTRACT

OBJECTIVE: This study was conducted to determine the relationship between their serum zinc levels and the CD4% in a cohort children living with HIV.

METHODS: One hundred asymptomatic, anti-retroviral Therapy (ART) naïve children living with HIV (participants) aged 5-60 months who were enrolled into the Paediatric HIV clinic of The University of Nigeria Teaching Hospital were recruited in the study over a 10-month period. Blood samples were collected in the morning from non-fasting participants and serum zinc levels were analysed using Atomic Absorption Spectrophotometer. The CD4% was ascertained using the CD4% easy count kit on the Partec® Cyflow Counter machine. Data were analysed using Statistical Package for the Social Sciences version 19.

RESULT: The median (IQR) serum zinc level for the participants was 55.5 µg/dl (49.75) while their median (IQR) CD4% was 27.79% (18.67). Males had a median (IQR) CD4% of 24.29% (19.10) which was significantly lower than those of females [32% (20.59) (p = 0.047)]. No significant relationship was found between CD4% and zinc levels among the subjects (r = -0.061, p = 0.557).

CONCLUSION: Serum zinc levels of asymptomatic ART naïve children living with HIV have no relationship with their CD4%.

PMID:35038323 | DOI:10.1093/tropej/fmab112

Eur J Endocrinol. 2022 Jan 1:EJE-21-1056.R1. doi: 10.1530/EJE-21-1056. Online ahead of print.

ABSTRACT

Background The UICC/AJCC TNM staging system for differentiated thyroid cancer (DTC) involves a single age cutoff as a prognostic criterion. Because a single cutoff is a dichotomization of what might be a sliding scale, using multiple age cutoffs might result into a better stage definition. The aim of our study was to investigate if using a two-step age-based cutoff would improve the TNM staging system regarding disease specific survival (DSS). Methods We retrospectively studied two cohorts of adult DTC patients from The Netherlands and Germany. DSS was analyzed for papillary (PTC) and follicular thyroid cancer (FTC) separately, investigating several two-step age-based cutoffs for those with distant metastases; below lower threshold classified as stage I, between lower and upper threshold as stage II, and above upper threshold as stage IV. Results We included 3074 DTC patients (77% PTC). For PTC, an age cutoff of 45 with 50 years had the best statistical model performance, while this was 25 with 40 years for FTC. However, differences with the optimal single age cutoffs of 50 years for PTC and 40 years for FTC were small. Conclusions The optimal two-step age-based cutoff to predict DSS is 45 with 50 years for PTC, and 25 with 40 years for FTC, rather than 55 years currently used for DTC. Although, these two-step age-based cutoffs were marginally better from a statistical, from a clinical point of view the recently defined optimal single age cutoffs of 50 years for PTC, and 40 years for FTC might be preferable.

PMID:35038308 | DOI:10.1530/EJE-21-1056

JMIR Public Health Surveill. 2022 Jan 6. doi: 10.2196/32426. Online ahead of print.

ABSTRACT

BACKGROUND: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province.

OBJECTIVE: This study aimed to validate the use of cremation data as a more timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality.

METHODS: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017-2019, grouped according to week, age, sex, and COVID-19 status. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 account for the entirety of the excess mortality.

RESULTS: Between 2017-2019, cremations were performed for 67.4% (95% CI: 67.3-67.5%) of deaths; the proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within three weeks of the data of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI: 14.6-19.3%) in all-cause mortality, a finding which was confirmed several months later with cremation data.

CONCLUSIONS: The percent of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies.

PMID:35038302 | DOI:10.2196/32426

Clin Child Psychol Psychiatry. 2022 Jan 17:13591045211067556. doi: 10.1177/13591045211067556. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the effect of anxiety of parent accompanying child on child’s anxiety during treatment.

METHODS: The study included two groups: one group with 80 children whose parents were anxious, and the other group with 80 children with non-anxious parents, totaling 160 children. Each group was further randomized into subgroups, with and without parents accompanying their children. The children’s heart rates were measured using a portable pulse oximeter during the treatment. The child’s perception was measured using the Wong-Baker Faces Rating Scale, and another pediatric dentist rated child’s behavior using the Frankl scale based on the treatment video that was limited to the child’s appearance.

RESULTS: The highest pulse rates were observed in children accompanied by an anxious parent (p < .001). Values on the Wong-Baker scale did not differ according to parental anxiety and parental presence (p > .05). According to the dentist, the presence of parents negatively affected the anxiety of the child (p = .025), while the effect of parents’ anxiety was not statistically significant (p = .514).

CONCLUSIONS: The anxiety of parent accompanying the child affects child’s anxiety. Parents with high anxiety appeared to negatively affect their children’s behavior.

PMID:35038278 | DOI:10.1177/13591045211067556

Appl Neuropsychol Adult. 2022 Jan 17:1-6. doi: 10.1080/23279095.2021.2023155. Online ahead of print.

ABSTRACT

The General Ability Measure for Adults (GAMA) is a brief nonverbal assessment of general intellectual ability. Presently, there is a lack of research involving the use of the GAMA in a high-functioning population. Aviation pilots (n = 59) were referred for a neuropsychological evaluation and were concluded to be cognitively intact. They were administered a battery that included the GAMA and Wechsler Adult Intelligence Scale – 4th edition (WAIS-IV). A paired samples t-test revealed that IQ scores on the GAMA were significantly lower than IQ scores on the WAIS-IV, with WAIS-IV IQ being 7.54 points higher on average. Fisher’s exact test determined there was significant disagreement in score classification between the tests, with individuals classified as Above Average on the WAIS-IV often being classified as Average on the GAMA. The GAMA appears to significantly underrepresent true IQ in both score and classification when compared to a more robust measure of intellectual assessment. Clinically, this suggests that IQ screeners, such as the GAMA, may not be appropriate for assessing patients who are suspected to be of higher premorbid functioning. Future research should expand on these results to assess the validity of verbal-based IQ screening measures in high-functioning populations.

PMID:35038276 | DOI:10.1080/23279095.2021.2023155

Clin Child Psychol Psychiatry. 2022 Jan 17:13591045211061800. doi: 10.1177/13591045211061800. Online ahead of print.

ABSTRACT

The Diagnostic Interview Schedule for Children Adolescents and Parents (DISCAP) is a semi-structured diagnostic interview for assessing psychiatric disorders in children and adolescents. Changes to diagnostic criteria introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) required the DISCAP to be revised accordingly. The aim of this study was to evaluate the reliability and validity of the updated DISCAP-5 in clinic-referred children. The DISCAP-5 was administered to parents of n=60 clinic-referred children aged 2-9 years with externalizing problems and a range of comorbid disorders. Inter-rater reliability data were collected using independent ratings of video-recorded DISCAP-5 interviews, and concurrent and discriminant validity were indexed against mother and father reports on the Strengths and Difficulties Questionnaire. Inter-rater reliability agreement was high for the presence and absence of any diagnosis, common externalizing (e.g., oppositional defiant disorder, conduct disorder) and internalizing disorders (separation anxiety disorder, generalized anxiety disorder), and severity of primary and secondary diagnoses. Rating scale data supported the concurrent and discriminant validity of diagnoses based on the DISCAP-5. The DISCAP-5 appears to provide valid and reliable data in the diagnostic assessment of clinic-referred children with behavioral and emotional difficulties across broad ranges of severity and complexity.

PMID:35038264 | DOI:10.1177/13591045211061800

PM R. 2022 Jan 17. doi: 10.1002/pmrj.12761. Online ahead of print.

NO ABSTRACT

PMID:35038235 | DOI:10.1002/pmrj.12761