Nevin Manimala

Neurobiol Aging. 2021 Apr 22;105:16-24. doi: 10.1016/j.neurobiolaging.2021.04.005. Online ahead of print.

ABSTRACT

Intracranial arteriosclerosis has been increasingly recognized as a risk factor for cognitive impairment and even dementia. A possible mechanism linking intracranial arteriosclerosis to cognitive impairment and dementia involves structural brain changes including cerebral small vessel disease (CSVD). To assess whether intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC), as proxies for intracranial arteriosclerosis, are related to CSVD. Within the population-based Rotterdam Study, between 2003 and 2006 a computed tomography (CT)-based measurement of ICAC and VBAC and at least one magnetic resonance imaging (MRI) measurement of structural brain changes were performed from 2005 onwards in 1,489 participants. To estimate the burden of calcification independent of age, we computed age-adjusted percentile curves for ICAC and VBAC separately, based on the calcification volumes. Using the longitudinal MRI data, we assessed whether a larger calcification burden accelerates structural brain changes using appropriate statistical models for repeated outcome measures. A larger burden of ICAC and VBAC was associated with an increase of CSVD markers accelerating over time. A larger burden of ICAC and VBAC was not significantly (p > 0.05) associated with accelerated brain atrophy. Arteriosclerosis is related to accelerating structural brain changes over time.

PMID:34004492 | DOI:10.1016/j.neurobiolaging.2021.04.005

Atherosclerosis. 2021 Apr 27;327:5-12. doi: 10.1016/j.atherosclerosis.2021.04.009. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: The association between hysterectomy and cardiovascular disease (CVD) remains controversial and research focusing on different types of CVD, especially ischemic heart disease, is scant.

METHODS: This observational study was conducted with the National Health and Nutrition Examination Survey (NHANES) 2007-2018 using propensity score matching, propensity score overlap weighting, and logistic regression.

RESULTS: Among 15,257 women, 3476 (22.78%) had hysterectomy. Compared with non-hysterectomized women, hysterectomized women are more likely to be older, obese, with lower education level, and lower annual family income. Less favorable outcomes often occurred in unadjusted analysis. In adjusted, matched, and weighted analyses, the associations between hysterectomy and all outcomes were consistent, including ischemic heart disease (OR_unadjusted = 3.18[95%CI, 2.76-3.66]; OR_adjusted = 1.38[95%CI, 1.09-1.73]; OR_matched = 1.37[95%CI, 1.07-1.75]; OR_weighted = 1.38[95%CI, 1.12-1.71]), coronary heart disease (OR_unadjusted = 3.31[95%CI, 2.71-4.05]; OR_adjusted = 1.43[95%CI, 1.04-1.98]; OR_matched = 1.46[95%CI, 1.04-2.05]; OR_weighted = 1.45[95%CI, 1.06-1.99]), heart attack (OR_unadjusted = 3.04[95%CI, 2.51-3.68]; OR_adjusted = 1.47[95%CI, 1.09-1.99]; OR_matched = 1.42[95%CI, 1.03-1.95]; OR_weighted = 1.45[95%CI, 1.10-1.91]) and angina pectoris (OR_unadjusted = 3.29[95%CI, 2.66-4.08]; OR_adjusted = 1.34[95%CI, 0.95-1.89]; OR_matched = 1.30[95%CI, 0.91-1.87]; OR_weighted = 1.33[95%CI, 0.98-1.81]). In hysterectomized women, there were no significant associations between bilateral ovariectomy and ischemic heart disease (OR_unadjusted = 1.24[95%CI, 0.99-1.54]; OR_adjusted = 1.05[95%CI, 0.80-1.38]; OR_matched = 1.16[95%CI, 0.86-1.55]; OR_weighted = 0.93[95%CI, 0.68-1.27]), female hormones use and ischemic heart disease (OR_unadjusted = 0.94[95%CI, 0.76-1.16]; OR_adjusted = 0.81[95%CI, 0.62-1.07]; OR_matched = 0.89[95%CI, 0.66-1.20]; OR_weighted = 1.14[95%CI, 0.88-1.49]).

CONCLUSIONS: Hysterectomy may increase the risk of ischemic heart disease, especially for coronary heart disease and heart attack, but not for angina pectoris. As for the hysterectomized women, bilateral ovariectomy and female hormones use do not affect ischemic heart disease.

PMID:34004485 | DOI:10.1016/j.atherosclerosis.2021.04.009

Am J Emerg Med. 2021 May 5;48:255-260. doi: 10.1016/j.ajem.2021.04.085. Online ahead of print.

ABSTRACT

PURPOSE: To determine if aztreonam as initial empiric treatment of adult septic shock is associated with increased mortality compared to the use of anti-pseudomonal beta-lactam agents.

METHODS: This was a multicenter, retrospective cohort study of 582 adult emergency department patients admitted to 12 acute care facilities within a single health system from January 2014 to December 2017 with septic shock receiving either aztreonam or an anti-pseudomonal beta-lactam for empiric treatment and discharged with an infection-related ICD-9 or ICD-10 code. The primary endpoint was in-hospital mortality.

RESULTS: Initial exposure to aztreonam was associated with increased hospital mortality compared to treatment with an anti-pseudomonal beta-lactam agent (22.7% vs. 12.9%, OR = 1.98, 95% CI: 1.27-3.11). When adjusted for APACHE II score, the treatment group effect on mortality remained statistically significant (OR = 1.74, 95% CI: 1.08-2.80). Aztreonam use was also associated with increased utilization of aminoglycosides (28.9% vs. 12.4%, p < 0.0001) and fluoroquinolones (50.5% vs. 25.8%, p < 0.01). There was no difference in hospital or intensive care unit length of stay in surviving patients between the two groups.

CONCLUSIONS: Compared to anti-pseudomonal beta-lactams, empiric treatment with aztreonam is associated with increased mortality and greater antibiotic exposure among patients with acute septic shock. These findings suggest that treatment with anti-pseudomonal beta-lactams should be prioritized over allergy avoidance whenever feasible.

PMID:34004470 | DOI:10.1016/j.ajem.2021.04.085

Int J Nurs Stud. 2021 Apr 24;119:103949. doi: 10.1016/j.ijnurstu.2021.103949. Online ahead of print.

ABSTRACT

BACKGROUND: Sexual and reproductive health of young people is an international concern with the increasing interest in healthy pregnancy and childbirth. mHealth interventions involve the use of mobile technologies for health support, have wide applications in clinical nursing practice, and play an increasingly important role in disseminating sexual and reproductive health-related information in emerging adulthood. However, there is a lack of evidence on the effects of mHealth intervention programs.

OBJECTIVES: This meta-analysis systematically assessed the effects of mHealth interventions on contraceptive use and pregnancy occurrence in emerging adulthood to identify the characteristics of a successful mHealth intervention program.

DESIGN: We conducted a systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES: Four central electronic databases (PubMed, Embase, CINAHL complete, and the Cochrane Library) were searched for relevant articles published from inception to May 2020.

REVIEW METHODS: Data extraction and quality appraisal were performed independently by two reviewers. Eleven papers on the effects of mHealth interventions on sexual and reproductive health in emerging adulthood were selected. The included studies were assessed for the risk of bias with the Risk of Bias 2 (RoB 2) tool. Overall and subgroup meta-analyses were conducted using STATA 16.0. Heterogeneity within studies was calculated using I².

RESULTS: We tested the effect of mHealth interventions on contraceptive use and pregnancy occurrence to identify the impact of sexual and reproductive health. mHealth interventions improved the use of contraception (OR 1.21; 95% CI: 1.02-1.43, I² = 20.7%; p = 0.234) although the effect on pregnancy occurrence was not significant (OR 0.80, 95% CI: 0.61-1.05, I² = 0.0%, p = 0.950). In subgroup analysis, mHealth interventions especially improved oral contraceptive use (OR 1.43, 95% CI: 1.15-1.77, I² = 0.0%, p = 0.784). Regarding the communication type, two-way communication showed statistically significant results with the mHealth intervention in the experimental group (OR 1.28, 95% CI: 1.06-1.54, I² = 0.0%, p = 0.872).

CONCLUSION: This meta-analysis found a positive effect of mHealth intervention on contraception, whereas the impact on pregnancy occurrences was limited. We also confirmed the factors underlying effective mHealth interventions from the results of our review. Our findings demonstrate that mHealth interventions may be suggested as a useful strategy to promote sexual and reproductive health in emerging adulthood.

PMID:34004469 | DOI:10.1016/j.ijnurstu.2021.103949

Nutrition. 2021 Apr 20;90:111273. doi: 10.1016/j.nut.2021.111273. Online ahead of print.

ABSTRACT

OBJECTIVE: Promising evidence suggests beneficial health effects of arabinogalactan, but little is known about the effect of this non-digestible carbohydrate on the gut microbiota, a crucial mediator of human health. The objective of this study was to investigate the effect of an arabinogalactan product (ResistAid) on the fecal microbiome and short-chain fatty acids and gastrointestinal tolerance in healthy adults in a randomized, double-blind, crossover trial.

METHODS: Thirty adults were randomly assigned to consume 15 g/d maltodextrin (control) or ResistAid for 6 wk.

RESULTS: At week 6, compared to placebo, ResistAid supplementation led to a significant decrease in the ratio of fecal Firmicutes to Bacteroidetes, driven by an increase in Bacteroidetes and a decrease in Firmicutes. Moreover, the relative abundance of Bifidobacterium tended to increase with ResistAid supplementation. Additionally, ResistAid significantly decreased the α-diversity of the fecal microbiome. Predicted functional abundances based on 16S rRNA sequences showed that ResistAid supplementation increased the gene abundance of the gut microbiome for α-l-rhamnosidase, β-fructosidase, and levanase, as well as tricarboxylic acid and vitamin B₆ biosynthesis pathways. Fecal isovaleric, valeric, and hexanoic acids were significantly lower after ResistAid consumption. There were no statistically significant changes in bowel habit, stool consistency, gastrointestinal tolerance symptoms, chemistry profile, metabolic panel, or vitals, suggesting that consumption of 15 g daily ResistAid over 6 wk is safe.

CONCLUSION: These results demonstrate that the gut microbiome composition and predicted functions can be modulated by ResistAid consumption, perhaps suggesting a mechanistic explanation on its reported benefits in metabolic parameters and the immune system.

PMID:34004416 | DOI:10.1016/j.nut.2021.111273

J Affect Disord. 2021 Apr 27;290:227-236. doi: 10.1016/j.jad.2021.04.033. Online ahead of print.

ABSTRACT

BACKGROUND: Psychiatric comorbidities may complicate depression treatment by being associated with increased role impairments. However, depression symptom severity might account for these associations. Understanding the independent associations of depression severity and comorbidity with impairments could help in treatment planning. This is especially true for depressed Veterans, who have high psychiatric comorbidity rates.

METHODS: 2,610 Veterans beginning major depression treatment at the Veterans Health Administration (VHA) were administered a baseline self-report survey that screened for diverse psychiatric comorbidities and assessed depression severity and role impairments. Logistic and generalized linear regression models estimated univariable and multivariable associations of depression severity and comorbidities with impairments. Population attributable risk proportions (PARPs) estimated the relative importance of depression severity and comorbidities in accounting for role impairments.

RESULTS: Nearly all patients (97.8%) screened positive for at least one comorbidity and half (49.8%) for 4+ comorbidities. The most common positive screens were for generalized anxiety disorder (80.2%), posttraumatic stress disorder (77.9%), and panic/phobia (77.4%). Depression severity and comorbidities were significantly and additively associated with impairments in multivariable models. Associations were attenuated much less for depression severity than for comorbidities in multivariable versus univariable models. PARPs indicated that 15-60% of role impairments were attributable to depression severity and 5-32% to comorbidities.

LIMITATIONS: The screening scales could have over-estimated comorbidity prevalence. The cross-sectional observational design cannot determine either temporal or causal priorities.

CONCLUSIONS: Although positive screens for psychiatric comorbidity are pervasive among depressed VHA patients, depression severity accounts for most of the associations of these comorbidities with role impairments.

PMID:34004405 | DOI:10.1016/j.jad.2021.04.033

J Affect Disord. 2021 May 5;290:211-218. doi: 10.1016/j.jad.2021.04.046. Online ahead of print.

ABSTRACT

BACKGROUND: Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD.

METHODS: In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors.

RESULTS: The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05).

LIMITATIONS: We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care.

CONCLUSIONS: PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.

PMID:34004403 | DOI:10.1016/j.jad.2021.04.046

J Affect Disord. 2021 Apr 25;290:197-201. doi: 10.1016/j.jad.2021.04.028. Online ahead of print.

ABSTRACT

BACKGROUND: Bipolar Affective Disorder (BPAD) accounts for 10-25% of all mood disorders in the geriatric population and 5% of all inpatient admissions to geropsychiatric units. Electroconvulsive therapy (ECT) is an effective treatment for all phases of BPAD, though only a few studies have focused on BPAD in the geriatric population. This study examines the safety and efficacy of ultra-brief right unilateral (UBRUL) ECT for patients with late-life bipolar depression (BD).

METHODS: A retrospective chart review was conducted of patients with late-life BD who received UBRUL ECT treatments. Symptomatic response was measured using pre- and post-ECT Quick Inventory of Depressive Symptomatology (QIDS-SR16) and Beck Depression Inventory (BDI-II) scores. Clinical improvement and cognitive change were measured using Clinical Global Impression-Improvement (CGI-I) and Electroconvulsive Cognitive Assessment (ECCA) scores.

RESULTS: Twenty-Seven elderly patients (mean age 69.1 ± 7.7 years) were included in the analysis. Baseline QIDS-SR16 was 17.3 ± 5.3 and BDI-II 30.0 ± 9.2. 80.0% (16/20) and 57.1% (4/7) of patients achieved response (50.0% decline) in their QIDS-SR16 and BDI-II scores, respectively. Remission rates in QIDS-SR16 (post-ECT scores ≤5) and BDI-II (post-ECT scores ≤12) were 65.0% (13/20) and 42.9% (3/7), respectively. Mean QIDS-SR16 and BDI-II scores were reduced by a statistically significant 68.2% and 50.5%, respectively (two-tailed, paired p-values <0.01) after ECT. CGI-I of ≤2 was attained by 85.2% (23/27) of patients. 85.7% (12/14) of patients saw no change or improvement in ECCA scores.

LIMITATIONS: Inherent complications of chart review regarding quality, availability, and homogeny of data.

CONCLUSIONS: UBRUL ECT is a safe and effective treatment for patients presenting with late-life BD.

PMID:34004401 | DOI:10.1016/j.jad.2021.04.028

Int J Med Inform. 2021 May 10;152:104485. doi: 10.1016/j.ijmedinf.2021.104485. Online ahead of print.

ABSTRACT

BACKGROUND: Ownership has significant impact on website motivation. Consumers may heavily rely on the health website ownership cue when assessing credibility and making behavioral response toward health information on it. Health websites were primarily divided into four different ownership types (i.e., governmental, organizational, commercial, and personal) in China’s context. However, research on Chinese consumer behavior toward different ownership types of health websites is scarce.

OBJECTIVES: To investigate the most credible and most commonly used health website ownership type among Chinese consumers, and to identify the influencing factors on perceived credibility, and actual usage of health websites.

METHODS: A cross-sectional survey of 1653 participants was conducted in 3-tier hospitals in 3 cities with different income levels. Multinomial logistic regression analyses were used to identify factors influencing Chinese consumers’ perceived credibility and actual use of health websites.

RESULTS: The most credible health website was the organizational, followed by the governmental, commercial, and personal. The most commonly used health website was the commercial, followed by the organizational, governmental, and personal. Individuals in medium-income and low-income cities were more likely than those in high-income cities to trust and use non-governmental health websites. Compared to the governmental health website, consumers of high-level hospitals were less likely than those of primary hospitals to trust and use personal health websites. Compared to the governmental health website, high-income individuals were more likely than low-income individuals to trust the personal health website, and use the organizational and commercial health website.

CONCLUSIONS: Both Chinese consumers’ perceived credibility and actual use of health website varied by ownership, and there was a gap between perceived credibility and actual usage of health website. Most sociodemographic factors had no statistically significant correlations with perceived credibility and actual usage of health website. City income level, consumer type and consumer income level were significantly associated with perceived credibility, actual usage of health websites.

PMID:34004399 | DOI:10.1016/j.ijmedinf.2021.104485

Int J Pediatr Otorhinolaryngol. 2021 Apr 29;146:110749. doi: 10.1016/j.ijporl.2021.110749. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine whether the two most common genetic mutations seen in Stickler Syndrome (SS) (COL2A1 and COL11A1) affect the incidence of mandibular distraction osteogenesis (MDO) and what impact Robin sequence (RS) has on diagnosis. SS is an autosomal dominant connective tissue disorder characterized by almost complete penetrance. COL2A1 and COL11A1 are the two most common mutations seen in SS patients. SS often presents at birth with RS, which is characterized by the triad of micrognathia, glossoptosis, and tongue-based airway obstruction. MDO is one surgical intervention that has been shown to be successful in relieving tongue base obstruction and is the surgical intervention of choice for this condition.

METHODS: A retrospective chart review was performed on all patients with a diagnosis of SS at a tertiary pediatric hospital between January 1, 2003 and December 31, 2018. The included patient charts were reviewed for demographic information, SS mutation, and history of MDO. Forty-six patients had a clinical diagnosis of SS. Of those, 31 met inclusion criteria which involved having a molecular diagnosis of SS and sufficient follow up information to determine if MDO was indicated or performed. Twenty-two of the 31 included patients had a diagnosis of RS (70.96%). Thirteen of the 31 patients (41.94%) included in this study required MDO as a neonate.

RESULTS: Fifty-percent of patients with type I (COL2A1) required MDO as a neonate compared to only 31% of patients with type II (COL11A1), though the difference between the two groups was not statistically significant.

CONCLUSION: The findings of this study suggest that patients with type I mutation may have a higher incidence of MDO than patients with a type II mutation, though further research with larger sample sizes is needed. This information is helpful in counseling those with SS or family history of SS about what they can expect related to RS and need for MDO based on genetic findings.

LEVEL OF EVIDENCE: 3.

PMID:34004386 | DOI:10.1016/j.ijporl.2021.110749