Tag: nevin manimala

Hernia. 2025 May 6;29(1):159. doi: 10.1007/s10029-025-03342-7.

ABSTRACT

PURPOSE: We sought to evaluate the risks for reoperation, recurrence, and groin pain following open inguinal hernia repair with a plug versus flat mesh.

METHODS: We conducted a cohort study including 90,319 patients ≥ 18 years who underwent first elective open inguinal hernia repair with polyester/polypropylene mesh within a US integrated healthcare system (1/2010-6/2023). Plug versus flat mesh were the treatment groups. Reoperation related to the index hernia repair, as well as other reoperation reasons, and recurrence during follow-up were primary outcomes, while 5-year postoperative groin pain (excluding first 6-month postoperative acute recovery period) was a secondary outcome. Multiple Cox regression was used to evaluate risk of longitudinal outcomes, while multiple logistic regression was used to evaluate groin pain, with covariate adjustment.

RESULTS: Plugs were used in 37,490 (41.5%) repairs; plug use declined from 53.0% in 2010 to 13.9% in the first six months of 2023. No difference in risk for reoperation (hazard ratio [HR] = 1.03, 95% confidence interval [CI] = 0.92-1.16) or recurrence (HR = 0.93, 95% CI = 0.83-1.04) was found for plug compared to flat mesh. A higher risk of reoperation for device infection was observed with plug use compared to flat mesh (HR = 2.71, 95% CI = 1.09-6.77). In adjusted analysis, no difference in the likelihood of groin pain was observed (odds ratio = 1.08, 95% CI = 1.00-1.17).

CONCLUSION: Plug mesh for open inguinal hernia repairs were not found to have improved outcomes compared to flat mesh but a higher risk of reoperation for infection. These findings align with the current literature, which generally advises against the use of mesh plugs due to associated risks and complications.

PMID:40327184 | DOI:10.1007/s10029-025-03342-7

J Gerontol A Biol Sci Med Sci. 2025 May 4:glaf096. doi: 10.1093/gerona/glaf096. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying effective risk assessment strategies and prediction models for frail populations is crucial for precise mortality risk identification and improved patient management. This study aimed to evaluate whether prediction models incorporating survey data combined with biomarkers, physical measurements, or both could enhance mortality risk prediction in frail individuals than survey-only models.

METHODS: 15,754 frail participants aged 40-72 from the UK Biobank were included. We used Cox models to assess all-cause mortality risk and Light Gradient Boosting Machines for variable selection by sex. Performance was evaluated through discrimination, calibration, and reclassification.

RESULTS: In the survey-only models, we selected 24 predictors for males and 19 for females; age, and number of treatments were the top predictors for both sexes. In the biomarker models, we selected 15 predictors for males and 24 for females. In the physical measurement models, we retained 24 predictors for males and 23 for females. The base models showed good discrimination: C-statistic was 0.73 (95% CI, 0.72-0.75) for males and 0.74 (95% CI, 0.72-0.76) for females in development, and 0.70 (95% CI, 0.65-0.75) for males and 0.78 (95% CI, 0.73-0.83) for females in validation. Although incorporating additional predictors led to some improvement in model performance, the overall enhancement was not substantial.

CONCLUSIONS: Survey-based models predicted mortality in frail individuals effectively, with only minor improvements from adding biomarkers or physical measurements. These findings highlighted the value of surveys in forecasting outcomes and informed personalized management strategies to improve health for the frail.

PMID:40326431 | DOI:10.1093/gerona/glaf096

Pharmacotherapy. 2025 May 6. doi: 10.1002/phar.70022. Online ahead of print.

ABSTRACT

OBJECTIVE: The Anticholinergic Drug Scale (ADS) is a commonly used measure of anticholinergic exposure. This study describes an expanded and revised version of the ADS (rADS) and its relationship with cultured cell-based serum anticholinergic activity (cSAA) and cognitive measures.

STUDY PARTICIPANTS: Adults aged 60 years and older with mild cognitive impairment (MCI), remitted major depressive disorder (rMDD), or both, participate in the Prevention of Alzheimer’s Dementia with Cognitive Remediation plus Transcranial Direct Current Stimulation (PACt-MD) study.

STUDY DESIGN: Cross-sectional investigation of data from the PACt-MD study.

MEASURES: The rADS includes ratings for 1047 distinct products, about twice as many as the originally published scale; previously published ratings were revised for 40 drugs. Total rADS scores were calculated as sums of ratings of all drugs taken by participants; cSAA was measured in the participants’ sera; cognitive performance included measures of executive function, language, processing speed, verbal memory, visuospatial memory, working memory, and an overall composite score.

STATISTICAL ANALYSIS: The relationship between rADS total scores and cSAA was examined using a Spearman rank correlation coefficient. Relationships between rADS total scores and cognitive performance measures were explored in multivariable linear regression models.

RESULTS: The sample included 310 participants (mean [standard deviation] age: 72 (6) years; 61.6% were women, and 81.6% had MCI [with or without rMDD]). Total rADS scores were positively correlated with cSAA (Spearman’s correlation coefficient: 0.178, p = 0.0016). Total rADS scores were not significantly associated with cognitive performance.

CONCLUSIONS: The revised scale is recommended as a replacement for the original ADS since it includes ratings for more drugs and was significantly, albeit weakly, associated with cSAA, similar to previous findings using the original ADS.

PMID:40326412 | DOI:10.1002/phar.70022

Eur J Psychotraumatol. 2025 Dec;16(1):2490329. doi: 10.1080/20008066.2025.2490329. Epub 2025 May 6.

ABSTRACT

Background: Psychological safety plays a vital role in rest, recovery, and fostering social connections. However, a history of trauma can predispose individuals to perceive heightened levels of threat and danger. Research suggests that a lack of psychological safety may be a defining biopsychosocial characteristic of posttraumatic stress disorder (PTSD). Persistent feelings of threat and danger are associated with a lack of psychological safety and may be predictive of PTSD. Our pioneering work reported on the development of the neuroception of psychological safety (NPSS), rooted in polyvagal theory, and consists of social engagement, compassion, and body sensations dimensions. Understanding more about the dimensionality of the NPSS and further establishing its psychometric properties was our priority.Objective: Our current research aimed to validate and test the reliability and dimensionality of the NPSS, using a large community sample (n = 2035) of adult residents in the UKMethod: We examined the internal and test-retest reliability, convergent, discriminant, and concurrent validity as well as dimensionality of the NPSS.Results: The 3-factor structure of the NPSS was replicated with regard to the absolute fit indices. Internal consistencies ranged from acceptable to excellent across the NPSS’s subscales. Providing support for the validity of the NPSS, scores were predictably related to team psychological safety, wellbeing, post-traumatic stress, burnout, body awareness, and personality, with effect sizes typically in the high to medium range. Scores on the NPSS were found to show good test-retest reliability.Conclusions: This study demonstrates the validity, reliability and dimensionality of the NPSS with an adult sample. Further work is underway to support and enhance understandings of psychological safety with diverse clinical populations impacted by trauma. The NPSS has applicability across a range of health and social care contexts, such as shaping new approaches to evaluating trauma treatments and enhancing trauma informed care.

PMID:40326393 | DOI:10.1080/20008066.2025.2490329

Int Health. 2025 May 6:ihaf051. doi: 10.1093/inthealth/ihaf051. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to assess the population and health system factors affecting the transferability of health kiosks in markets in Kenya.

METHODS: A cross-sectional study with a partially mixed concurrent dominant status design was conducted among 843 households, policy actors, market chairpersons and champions, community health promoters and health workers. A χ2 test was used to test for independence with variables with a statistical significance (p<0.05) subjected to logistic regression. Qualitative data were transcribed verbatim to form nodes and themes.

RESULTS: Level of income, knowledge, awareness and perception of cardiovascular disease (CVD) risk factors were associated with 27.5% of Nyeri respondents earning ≥Ksh 10 000 monthly compared with Vihiga respondents (17.3%). Vihiga respondents were likely to identify excessive alcohol consumption as a cause of CVD. Vihiga had fair (40%) and good (26.6%) awareness levels towards CVDs compared with Nyeri respondents (36.3% and 19.7%, respectively). Vihiga respondents had a higher positive perception towards health services at the local facility compared with Nyeri respondents.

CONCLUSIONS: CVD burden, low awareness levels, low health insurance cover and the poor attitude of health workers have the potential to affect the transferability of a health intervention such as a health market kiosk.

PMID:40326387 | DOI:10.1093/inthealth/ihaf051

Neurorehabil Neural Repair. 2025 May 6:15459683251335316. doi: 10.1177/15459683251335316. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a common challenge for people with Parkinson’s disease (PwPD), driven by balance impairments and misaligned perceptions of balance abilities.

OBJECTIVE: This study investigated the replicability and generalizability of the relationship between balance ability and perception discordance and fall risk.

METHODS: Using baseline data from 2 clinical trials involving 171 PwPD, discordance was calculated using the Activities Specific Balance Confidence Scale and Timed Up and Go (TUG) or the Mini Balance Evaluation System’s Test (MiniBEST).

RESULTS: Findings supported the replicability of discordance as a predictor of fall risk, with results consistent across measures. While TUG-derived discordance was statistically significant, MiniBEST-derived discordance showed generalizability without statistical inferiority.

CONCLUSION: These results emphasize the relevance of balance perception and its misalignment with ability as fall risk predictors.

PMID:40326378 | DOI:10.1177/15459683251335316

Nutr Hosp. 2025 Apr 30. doi: 10.20960/nh.05616. Online ahead of print.

ABSTRACT

BACKGROUND: the FM/FFM ratio has been proposed as a new body composition variable. However, the association between FM/FFM ratio and physical function in older adults remains limited. Therefore, the aim of this study was to analyze the association between FM/FFM ratio and muscle strength, static balance, and exercise capacity in older adults.

METHODS: this was a cross-sectional study involving 392 older adults from Londrina, Brazil. Subjects underwent body composition analysis by bioelectrical impedance, and assessments for aerobic capacity, muscle strength and static balance including the 6-minutes walking test, handgrip strength and one-legged stance test. Statistical analysis was conducted using correlation tests and lineal regression models adjusted for age and gender. The statistical significance considered was p < 0.05.

RESULTS: a total of 392 older adults participated (mean age = 69.77 years; women: 74.7 %). The FM/FFM ratio was significantly associated with muscle strength (β = -22.779, 95 % CI: -26.741 to -18.818; p < 0.001), static balance (β = -14.335, 95 % CI: -19.980 to -8.690; p < 0.001), and exercise capacity (β =-98.937, 95 % CI: -152.286 to -45.588, p < 0.001). After adjusting for age and gender, FM/FFM ratio was an important predictor of muscle strength (β = -4.687, 95 % CI: -8.646 to -0.728; p = 0.020) and static balance (β = -18.361, 95 % CI: -24.943 to -11.778; p < 0.001).

CONCLUSIONS: the FM/FFM ratio is an important clinical measure of body composition that is significantly associated with key indicators of physical performance, including muscle strength, static balance, and exercise capacity in older adults.

PMID:40326320 | DOI:10.20960/nh.05616

Nutr Hosp. 2025 Apr 30. doi: 10.20960/nh.05569. Online ahead of print.

ABSTRACT

INTRODUCTION: bariatric surgery is an effective treatment but weight loss does not occur only at the expense of fat mass and preserving muscle mass is a priority.

OBJECTIVE: to evaluate the improvement in nutritional parameters of patients undergoing bariatric surgery after supplementation with beta-hydroxy-β-methylbutyrate (HMB).

METHODOLOGY: intervention study comparing 2 types of protein supplementation (with and without HMB) in the 3 months after surgery. All patients underwent a baseline and 3-month anthropometric, body composition, dynamometry and analytical study with usual nutritional determination, inflammation markers (CRP and IL-6), muscle markers (irisin, CK) and MRO (CTX, P1NP, sclerostin). Adherence was assessed and physical activity was recorded.

RESULTS: a total of 24 patients (87.5 % women) with a mean age of 52 ± 8 years were included. There were no statistically significant differences (p > 0.05) between intervention vs control in weight loss (17.5 ± 1.3 vs 19.1 ± 1.7 kg), MME (3.07 ± 1.7 vs 3.06 ± 136 kg), MG (12.9 ± 0.8 vs 14.7 ± 1.4 kg) or in dynamometry. Prealbumin levels in the intervention group were significantly higher (21 ± 1 vs 18 ± 0.8 mg/dl, p = 0.04) but there were no significant differences in the rest of the analytical markers. Significant changes in weight and fat mass were observed depending on physical activity.

CONCLUSIONS: after bariatric surgery, a significant weight reduction has been seen both at the expense of fat mass and lean mass in all patients. HMB supplementation has not shown statistically significant differences compared to the other protein supplementation to preserve muscle mass or function.

PMID:40326309 | DOI:10.20960/nh.05569

Brain. 2025 May 6:awaf172. doi: 10.1093/brain/awaf172. Online ahead of print.

ABSTRACT

Migraine has an assumed polygenic basis, but the genetic risk variants identified in genome-wide association studies only explain a proportion of the heritability. We aimed to develop machine learning models, capturing non-additive and interactive effects, to address the missing heritability. This was a cross-sectional population-based study of participants in the second and third Trøndelag Health Study. Individuals underwent genome-wide genotyping and were phenotyped based on validated modified criteria of the International Classification of Headache Disorders. Four datasets of increasing number of genetic variants were created using different thresholds of linkage disequilibrium and univariate genome-wide associated p-values. A series of machine learning and deep learning methods were optimized and evaluated. The genotype tools PLINK and LDPred2 were used for polygenic risk scoring. Models were trained on a partition of the dataset and tested in a hold-out set. The area under the receiver operating characteristics curve was used as the primary scoring metric. Classification by machine learning was statistically compared to that of polygenic risk scoring. Finally, we explored the biological functions of the variants unique to the machine learning approach. 43,197 individuals (51% women), with a mean age of 54.6 years, were included in the modelling. A light gradient boosting machine performed best for the three smallest datasets (108, 7,771 and 7,840 variants), all with hold-out test set area under curve at 0.63. A multinomial naïve Bayes model performed best in the largest dataset (140,467 variants) with a hold-out test set area under curve of 0.62. The models were statistically significantly superior to polygenic risk scoring (area under curve 0.52 to 0.59) for all the datasets (p<0.001 to p=0.02). Machine learning identified many of the same genes and pathways identified in genome-wide association studies, but also several unique pathways, mainly related to signal transduction and neurological function. Interestingly, pathways related to botulinum toxins, and pathways related to the calcitonin gene-related peptide receptor also emerged. This study suggests that migraine may follow a non-additive and interactive genetic causal structure, potentially best captured by complex machine learning models. Such structure may be concealed where the data dimensionality (high number of genetic variants) is insufficiently supported by the scale of available data, leaving a misleading impression of purely additive effects. Future machine learning models using substantially larger sample sizes could harness both the additive and the interactive effects, enhancing precision and offering deeper understanding of genetic interactions underlying migraine.

PMID:40326299 | DOI:10.1093/brain/awaf172

J Clin Hypertens (Greenwich). 2025 May;27(5):e70053. doi: 10.1111/jch.70053.

ABSTRACT

Screenings for hypertension, diabetes, and high cholesterol are widely conducted in routine clinical practice for cardiovascular disease (CVD) prevention. However, few studies have investigated whether these screenings could eventually lead to lower risks of hard outcomes such as mortality. This cohort study aimed to examine directly the association of screenings for hypertension, diabetes, and high cholesterol with all-cause and cardiovascular mortality and whether the association, if existent, varied with important characteristics. A nationally representative sample of 86 587 US adults without the three conditions and CVD at baseline were recruited. The history of screenings for the three conditions was elicited by a series of questions in the surveys. All-cause and cardiovascular mortality were ascertained by linkage to National Death Index records through December 31, 2019. The association of screenings with mortality was investigated by multivariable Cox regression analysis and expressed as hazard ratio (HR) with 95% confidence interval (CI), adjusting for major risk factors of CVD and mortality. The “1 screening,” “2 screenings,” “3 screenings,” and “any screening” (combining the above three) groups were compared with the “no screening” group separately. During a median follow-up of 51 months (4.3 years), 1783 participants died and 366 of them were attributed to CVD. After adjusting for all covariates, no statistically significant association was found between “any screening” and all-cause mortality (HR = 1.08, 95% CI 0.92-1.26) or cardiovascular mortality (HR = 1.06, 95% CI 0.76-1.47). The results were consistent across various subgroups. The associations of “1 screening,” “2 screenings,” and “3 screenings” respectively with all-cause and cardiovascular mortality were not statistically significant either (HRs ranging from 0.65 to 1.40). Overall, in this population of US general adults, there was no evidence that screening for hypertension, diabetes, and high cholesterol could lead to lower all-cause or cardiovascular mortality.

PMID:40326297 | DOI:10.1111/jch.70053