Tag: nevin manimala

J Affect Disord. 2021 Mar 31;288:129-135. doi: 10.1016/j.jad.2021.03.074. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to explore the mediational effects of emotional and behavioral problems on the association between childhood emotional abuse and depressive symptoms among college students.

METHODS: Data were drawn from 60 universities from 10 provinces in China (n=30,374). Information about childhood maltreatment, depressive symptoms, emotional and behavioral problems were gathered through the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Strengths and Difficulties Questionnaire (SDQ), respectively. Univariable and multivariable logistic regression models and mediating models were used.

RESULTS: After controlling for demographic factors, childhood emotional abuse was the strongest risk factor for depressive symptoms (adjusted odds ratio (aOR)=2.54, 95%CI=2.27-2.85). The relationship between childhood emotional abuse and depressive symptoms was partially mediated by emotional and behavioral problems with 68.7% total indirect effect. Among the 5 identified subtypes of emotional and behavioral problems, the mediating effects of emotional problems (57.3%) and hyperactivity (28.6%) were higher than peer problems (7.8%) and prosocial behavior (3.6%). Conduct problems did not show a significant mediating effect (p>0.05).

LIMITATIONS: The cross-sectional design is limited to make inferences about causality.

CONCLUSIONS: Childhood emotional abuse was strongly associated with depressive symptoms in college students. Of the five identified subtypes of emotional and behavioral problems, four subtypes mediated the relationship between childhood emotional abuse and depressive symptoms, including emotional problems, hyperactivity, peer problems and prosocial behavior.

PMID:33878646 | DOI:10.1016/j.jad.2021.03.074

J Neurol Sci. 2021 Apr 17;425:117447. doi: 10.1016/j.jns.2021.117447. Online ahead of print.

ABSTRACT

Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving immunosuppressive therapy is limited, and the benefit of TB preventative therapy in these patients is uncertain. We audited observational data collected at an MG clinic in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy. The total time that the cohort was at risk (patient-years) was used as the denominator to calculate TB incidence after immunosuppressive therapy initiation. Multivariate logistic regression analysis was performed to identify differences between patients who did, and those who did not, develop TB. Of 480 cases, only two received TB preventative therapy when starting immunotherapy. Seventeen of 282 (6%) patients tested, were HIV-infected. With a median follow-up of 3.6 years (interquartile range 1;7.5), 13 (3%) patients (all HIV-uninfected) developed TB (38% within 12 months of starting immunosuppressive therapy). The incidence rate of TB in the study population (≤401/100000 person-years) was not higher than that for the hospital’s catchment area during the same period (>500/100000 population). The maximum dose of prescribed prednisone was higher in patients who developed TB compared to those who did not (median: 0.6 mg/kg/day vs 0.4; 0.002); Odds ratio for TB increased 1.26-fold for every 0.1 mg/kg/day increase in maximum dose (p = 0.001). In our TB endemic setting, receiving immunosuppressive therapy was not associated with excess TB in MG patients. Preventative therapy may be considered in those who are at greatest risk of developing TB and receiving high-dose prednisone.

PMID:33878657 | DOI:10.1016/j.jns.2021.117447

Neural Netw. 2021 Feb 16;141:98-106. doi: 10.1016/j.neunet.2021.01.013. Online ahead of print.

ABSTRACT

Firstly, an intermittent event-triggered control (IETC), as a combination of intermittent control and event-triggered control, is proposed. Then, the quasi-synchronization problem of coupled memristive neural networks with time-varying delays (CDMNN) is discussed under this IETC. To include more of the existing work, aperiodic intermittent control and event-triggered control with combined measurement errors are adopted in the IETC. Under the IETC, it is shown that Zeno behavior cannot be exhibited for CDMNN. At the same time, two new differential inequalities are established, and some simple and practical criteria for CDMNN quasi-synchronization and synchronization are obtained by using these inequalities. In the obtained results, synchronization is a spatial case of quasi-synchronization, and the activation functions of DMNN do not need to be bounded. Finally, a numerical example and some simulations are provided to test the results in theoretical analysis.

PMID:33878659 | DOI:10.1016/j.neunet.2021.01.013

Child Abuse Negl. 2021 Apr 17;117:105067. doi: 10.1016/j.chiabu.2021.105067. Online ahead of print.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) are widespread and are associated with adverse outcomes in later life, yet few studies have explored their prevalence and consequences in New Zealand.

OBJECTIVES: To provide prevalence estimates of ACEs in New Zealand using a large sample of adults, and to explore the associations between ACEs and experience of violence by intimate partners and non-partners in adulthood.

PARTICIPANTS AND SETTING: 2,887 participants (1464 female, 1423 male) from the 2019 New Zealand Family Violence Survey, a population based study conducted in New Zealand between March 2017-March 2019.

METHODS: Descriptive statistics for prevalence of each of the eight ACE types, and cumulative ACE scores were estimated across sociodemographic groups. Multivariate logistic regression models were developed to assess association between ACEs and five IPV and two non-partner violence variables.

RESULTS: ACEs were prevalent and co-occurring, with 55 % (95 % CI 53.2 %-56.8 %) of respondents reporting having experienced at least one ACE and 11.6 % (95 % CI 10.4 %-12.8 %) reporting at least four ACEs before the age of 18. Those who were younger, had lower socioeconomic status, and who identified as Māori reported higher prevalence of ACEs. Exposure to any ACE was significantly associated with later exposure to IPV and non-partner violence.

CONCLUSIONS: The findings provide the first comprehensive assessment of the prevalence of ACEs in the New Zealand population. They suggest that prevention of childhood trauma, maltreatment, and family dysfunction remain important and interconnected public health goals that need to be addressed to support the wellbeing of children and adults.

PMID:33878644 | DOI:10.1016/j.chiabu.2021.105067

Eur J Oncol Nurs. 2021 Apr 17;52:101958. doi: 10.1016/j.ejon.2021.101958. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated experiences and levels of distress and resilience of Danish cancer patients during the second wave of the COVID-19 pandemic.

METHODS: The mixed methods design included a subset of cancer patients who responded to a cross-sectional survey in May 2020. Data were collected through telephone interviews. The National Comprehensive Cancer Network Distress Thermometer (NCCN DT), and Connor-Davidson-Resilience Scale (CD-RISC2) were used to measure distress and resilience. Data were analysed by thematic analysis and descriptive statistics.

RESULTS: Forty patients with lung, breast, colorectal and skin (melanoma) cancer were included; 65% were women. Mean age was 62.2 years (standard deviation [SD], 13.2). Most patients had curable disease (65%); 50% were in treatment and 50% in post-treatment follow up. The interviews revealed four themes: 1) the cost of living with cancer during COVID-19, 2) changes in cancer care delivery, 3) particularly vulnerable, and 4) importance of family support. Mean NCCN DT score was 2.3 (SD, 2.6) while the mean CD-RISC2 score was 7.25 (SD, 1.1).

CONCLUSION: Despite drastic changes in daily life imposed by COVID-19 restrictions, Danish cancer patients had remarkably low levels of distress and high levels of resilience. Patients in active treatment, with comorbidities or elderly felt vulnerable. Family support was invaluable in critical times.

PMID:33878634 | DOI:10.1016/j.ejon.2021.101958

JMIR Ment Health. 2021 Apr 20;8(4):e25097. doi: 10.2196/25097.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being.

OBJECTIVE: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic.

METHODS: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence.

RESULTS: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19-generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with ~80% accuracy.

CONCLUSIONS: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time.

PMID:33877051 | DOI:10.2196/25097

J Bone Joint Surg Am. 2021 Mar 11. doi: 10.2106/JBJS.20.01640. Online ahead of print.

ABSTRACT

BACKGROUND: Despite previous reports of improvements for athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS), many do not achieve clinically relevant outcomes. The purpose of this study was to develop machine learning algorithms capable of providing patient-specific predictions of which athletes will derive clinically relevant improvement in sports-specific function after undergoing hip arthroscopy for FAIS.

METHODS: A registry was queried for patients who had participated in a formal sports program or athletic activities before undergoing primary hip arthroscopy between January 2012 and February 2018. The primary outcome was achieving the minimal clinically important difference (MCID) in the Hip Outcome Score-Sports Subscale (HOS-SS) at a minimum of 2 years postoperatively. Recursive feature selection was used to identify the combination of variables, from an initial pool of 26 features, that optimized model performance. Six machine learning algorithms (stochastic gradient boosting, random forest, adaptive gradient boosting, neural network, support vector machine, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and applied to an independent testing set of patients. Models were evaluated using discrimination, decision-curve analysis, calibration, and the Brier score.

RESULTS: A total of 1,118 athletes were included, and 76.9% of them achieved the MCID for the HOS-SS. A combination of 6 variables optimized algorithm performance, and specific cutoffs were found to decrease the likelihood of achieving the MCID: preoperative HOS-SS score of ≥58.3, Tönnis grade of 1, alpha angle of ≥67.1°, body mass index (BMI) of >26.6 kg/m2, Tönnis angle of >9.7°, and age of >40 years. The ENPLR model demonstrated the best performance (c-statistic: 0.77, calibration intercept: 0.07, calibration slope: 1.22, and Brier score: 0.14). This model was transformed into an online application as an educational tool to demonstrate machine learning capabilities.

CONCLUSIONS: The ENPLR machine learning algorithm demonstrated the best performance for predicting clinically relevant sports-specific improvement in athletes who underwent hip arthroscopy for FAIS. In our population, older athletes with more degenerative changes, high preoperative HOS-SS scores, abnormal acetabular inclination, and an alpha angle of ≥67.1° achieved the MCID less frequently. Following external validation, the online application of this model may allow enhanced shared decision-making.

PMID:33877058 | DOI:10.2106/JBJS.20.01640

Plast Reconstr Surg. 2021 Apr 20. doi: 10.1097/PRS.0000000000008194. Online ahead of print.

ABSTRACT

BACKGROUND: Implant-based breast reconstruction accounts for the vast majority of breast reconstruction procedures and is commonly performed with human acellular dermal matrix. There is no consensus as to the optimal human acellular dermal matrix preparation, and high-quality evidence concerning comparative effectiveness is lacking. This study is the first prospective, multicenter, randomized controlled clinical trial to compare human acellular dermal matrix-related complications of the two most commonly used human acellular dermal matrices in implant-based breast reconstruction. The authors hypothesize that there will be no difference in infection, seroma, and reconstructive failure between FlexHD Pliable and AlloDerm RTU.

METHODS: The authors conducted a Level 1 prospective, randomized, controlled, multicenter clinical trial to assess complications associated with the use of two human acellular dermal matrices in immediate postmastectomy implant-based breast reconstruction across seven clinical sites. Group A patients received FlexHD Pliable (113 patients with 187 breast reconstructions), and group B patients received AlloDerm RTU (117 patients with 197 breast reconstructions).

RESULTS: There was no significant difference with respect to patient demographics, indications, comorbidities, and reconstruction approach between groups. Mean follow-up time was 10.7 ± 3.2 months. There was no statistical difference in the overall matrix-related complications between groups A and B (4.3 percent versus 7.1 percent, p = 0.233). Obesity (OR, 1.14; 95 percent CI, 1.05 to 1.24; p = 0.001) and prepectoral placement of matrix (OR, 4.53; 95 percent CI, 1.82 to 11.3; p = 0.001) were independently associated with greater risks of overall matrix-related complications.

CONCLUSION: This work supports the use of human acellular dermal matrices in implant-based breast reconstruction and demonstrates no significant difference in matrix-related complication rates between FlexHD Pliable and AlloDerm RTU.

PMID:33877063 | DOI:10.1097/PRS.0000000000008194

Int J Stroke. 2021 Apr 20:17474930211013285. doi: 10.1177/17474930211013285. Online ahead of print.

ABSTRACT

Introduction There is controversy if direct to comprehensive center âmothershipâ (MS) orstopping at primary center for thrombolysis before transfer to comprehensive center âdrip-and-shipâ (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared.Results A total of 7,824 patientsâ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptomâs onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care.Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

PMID:33877018 | DOI:10.1177/17474930211013285

Eur Urol Focus. 2020 Oct 23:S2405-4569(20)30274-1. doi: 10.1016/j.euf.2020.09.015. Online ahead of print.

ABSTRACT

BACKGROUND: Focal therapy (FT) with its favorable side-effect profile represents an option between active surveillance and traditional whole-gland treatment in localized prostate cancer (PCa). Consensus statements recommend eligibility criteria based on magnetic resonance imaging (MRI)-targeted and systematic combination biopsy.

OBJECTIVE: To estimate the future potential of FT by analyzing the number of men eligible for FT among all men with biopsy-proven PCa and to judge the potential of different energy sources.

DESIGN, SETTING, AND PARTICIPANTS: Consensus criteria on FT were analyzed. Patients with biopsy-proven PCa from six tertiary referral hospitals and one outpatient practice in Germany had received a software-based combination biopsy. Men with Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions based on PI-RADS v2 were included.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients were analyzed for potential treatment by FT and hemiablation. MRI lesions were mapped according to prostatic zones.

RESULTS AND LIMITATIONS: In total, 2371 patients were analyzed. According to consensus criteria (biopsy-proven unifocal lesion of International Society of Urological Pathology [ISUP] grade group ≤2, prostate-specific antigen [PSA] ≤15ng/mL, and life expectancy >10yr), 303 patients (12.8%; ISUP 1: n=148 [6.2%]; ISUP 2: n=155 [6.5%]) were potential candidates for FT. A maximum PSA level of <10ng/mL would exclude further 60 (2.5%) of these men. The eligibility for hemiablation is slightly higher (16.2%). Unifocal lesions (n=288) were equally distributed within the prostate (anteriorly [31%], apically [29%], and dorsally [36%]).

CONCLUSIONS: With adherence to consensus statements, only a minority of PCa patients present as potential candidates for FT. Distribution of tumor localization suggests the need for different energy modalities to warrant an optimal FT treatment.

PATIENT SUMMARY: We analyzed how many men who receive a magnetic resonance imaging-targeted and systematic prostate biopsy are candidates for the experimental focal therapy of the prostate. When following expert recommendations, only a small number of men are potential candidates for this alternative treatment.

PMID:33877047 | DOI:10.1016/j.euf.2020.09.015