Tag: nevin manimala

JAMA Netw Open. 2024 Nov 4;7(11):e2445309. doi: 10.1001/jamanetworkopen.2024.45309.

ABSTRACT

IMPORTANCE: Cardiovascular-kidney-metabolic (CKM) syndrome-a novel, multistage, multisystem disorder as defined by the American Heart Association-is highly prevalent in the US. However, the prevalence of CKM stages by social determinants of health (SDOH) remains unclear.

OBJECTIVE: To investigate whether the prevalence of CKM stages varies by SDOH in US adults.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2018) and included a nationally representative sample of adults aged 30 to 79 years through complex, multistage probability sampling. Data were analyzed from April 1 to June 15, 2024.

EXPOSURES: The exposures included 5 CKM stages (ie, stages 0-4) reflecting progressive pathophysiology, with advanced (stages 3 or 4) and nonadvanced (stages 0, 1, or 2) disease. CKM stages were defined based on risk factors for metabolic syndrome, cardiovascular disease, and chronic kidney disease.

MAIN OUTCOME AND MEASURES: The main outcome was the age-standardized prevalence of CKM stages and advanced CKM stages across SDOH, including education, marital status, family income, food security, health insurance, employment, home ownership, and health care access.

RESULTS: Among 29 722 participants (weighted mean [SE] age, 50.8 [0.1] years; weighted 50.7% male), the age-standardized prevalence of CKM stages 0 to 4 was 13.6% (95% CI, 13.0%-14.3%), 29.9% (95% CI, 29.1%-30.7%), 43.7% (95% CI, 42.9%-44.5%), 4.7% (95% CI, 4.4%-5.0%), and 8.1% (95% CI, 7.6%-8.5%), respectively. Significant differences were observed in the prevalence of CKM stages across all unfavorable SDOH of interest compared with their favorable counterparts, with unemployment (18.8% [95% CI, 17.7%-20.1%] vs 11.4% [95% CI, 11.0%-11.9%]), low family income (16.1% [95% CI, 15.4%-16.8%] vs 10.1% [95% CI, 9.5%-10.7%]), and food insecurity (18.3% [95% CI, 17.1%-19.6%] vs 11.7% [95% CI, 11.2%-12.2%]) associated with an increased likelihood of advanced CKM stages. Participants with 2 or more unfavorable SDOH were more likely to have advanced CKM stages (age-standardized prevalence, 15.8% [95% CI, 15.2%-16.5%] vs 10.5% [95% CI, 9.9%-11.1%] with <2 unfavorable SDOH). Living in a rented home (15.9% [95% CI, 14.7%-17.0%] vs 9.3% [95% CI, 8.7%-9.9%] owning the home) or not living with a partner (13.2% [95% CI, 12.3%-14.3%] vs 9.2% [95% CI, 8.5%-9.8%] living with a partner) increased the likelihood of advanced CKM stages in female but not male participants.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, disparities in the prevalence of CKM stages by SDOH, particularly family income, food security, and employment, with notable sex differences, were observed in US adults. These findings highlight the need to address inequities in CKM syndrome through targeted interventions.

PMID:39556396 | DOI:10.1001/jamanetworkopen.2024.45309

JAMA Netw Open. 2024 Nov 4;7(11):e2445525. doi: 10.1001/jamanetworkopen.2024.45525.

ABSTRACT

IMPORTANCE: The burden of liver cancer varies worldwide. An upward trend in both hepatocellular carcinoma (HCC) incidence and mortality in the past 2 decades has been observed.

OBJECTIVE: To assess observed HCC-related age-standardized mortality rates (ASMRs) in the US for 2006 to 2022 and provide ASMR projections through 2040.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the National Vital Statistics System, which is accessible through the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research website. Data on deaths attributed to HCC (from January 1, 2006, to December 31, 2022) were obtained for adults 25 years or older and were stratified by liver disease etiology, age, sex, and race and ethnicity. Etiologies included alcohol-associated liver disease (ALD), hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction-associated steatotic liver disease (MASLD).

MAIN OUTCOMES AND MEASURES: The main outcomes were (1) observed ASMRs of HCC per 100 000 persons using Joinpoint regression (National Cancer Institute) to assess trends during 2006 to 2022 and (2) ASMRs projected for 2023 to 2040 using Prophet and AutoARIMA modeling.

RESULTS: This study included 188 280 HCC-related deaths from 2006 to 2022. Most deaths occurred among males (77.4%). The annual percentage change was 4.1% (95% CI, 2.2% to 7.7%) for 2006 to 2009 and decreased to 1.8% (95% CI, 0.7% to 2.0%) for 2009 to 2022, with an overall observed ASMR of 5.03 per 100 000 persons in 2022 and a projected ASMR of 6.39 per 100 000 persons by 2040, with consistent trends for both sexes. By etiology, ASMRs decreased for HCV- and HBV-related mortality but increased for ALD- and MASLD-related mortality. In 2022, MASLD surpassed HBV as the third-leading cause of HCC-related death and was projected to overtake HCV in 2032 as the second-leading cause; ALD was projected to be the leading cause of HCC-related death in 2026. In 2022, the ASMR was higher among individuals aged 65 years or older compared with those aged 25 to 64 years (18.37 vs 1.79 per 100 000 persons). The American Indian or Alaska Native population had the largest increase in projected ASMR by 2040 (14.71 per 100 000 persons) compared with the Asian population (3.03 per 100 000 persons).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, ASMRs for ALD- and MASLD-related HCC death increased rapidly from 2006 to 2022; ALD-related HCC was projected to be the leading cause by 2026, with MASLD as the second-leading cause by 2032. These findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC death.

PMID:39556395 | DOI:10.1001/jamanetworkopen.2024.45525

JAMA Netw Open. 2024 Nov 4;7(11):e2445536. doi: 10.1001/jamanetworkopen.2024.45536.

ABSTRACT

IMPORTANCE: Federally qualified health centers (FQHCs) have increasingly participated in the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), one of the most widespread value-based programs. Although FQHCs may strengthen ACOs’ ability to provide affordable care to diverse Medicare beneficiaries, evidence on ACOs’ performance by FQHC participation is limited.

OBJECTIVES: To compare beneficiary characteristics, utilization, expenditure, and quality between ACOs with and without FQHC participation and assess changes in ACO performance after including first FQHCs.

DESIGN, SETTING, AND PARTICIPANTS: Using MSSP public use files, this cross-sectional study compared performance of ACOs that always had FQHC participation with ACOs that never had FQHC participation from January 1, 2016, to December 31, 2022, supplemented with staggered difference-in-differences analyses of ACOs’ first-time inclusion of FQHCs on performance measures. Data analysis was performed from December 1, 2023, to February 29, 2024.

EXPOSURE: Participation of FQHCs in the MSSP.

MAIN OUTCOMES AND MEASURES: Measures of ACO-assigned beneficiaries, utilization, expenditure, and quality per ACO-year.

RESULTS: Among 752 ACOs in the descriptive analysis, 140 ACOs always had at least 1 FQHC participant, whereas 612 ACOs never had FQHC participants. Compared with ACOs that never had FQHC participation, those that always had FQHC participation provided care to more socioeconomically disadvantaged beneficiaries (mean [SD] with dual eligibility, 2035.8 [2110.6] vs 1040.9 [1084.2] person-years; with disability, 3341.1 [3474.9] vs 1705.1 [1664.9] person-years; in racial and ethnic minoritized groups, 3690.6 [4118.4] vs 2515.1 [2762.9] person-years), with fewer primary care visits (mean [SD], 9956.6 [1926.3] vs 10 858.8 [2383.4] per 1000 person-years), more emergency department visits (mean [SD], 771.6 [190.9] vs 657.2 [160.0] per 1000 person-years), and lower levels of several quality measures. In the difference-in-differences analysis, 43 ACOs included FQHCs for the first time. Including first FQHCs was associated with increases of 872.9 dual-eligible (95% CI, 345.9-1399.8), 1137.6 disability (95% CI, 390.1-1885.1), and 1350.8 racial and ethnic minority (95% CI, 447.4-2254.1) person-years, with increases in rates of influenza immunization (5.9 percentage points [pp]; 95% CI, 1.4-10.4 pp), tobacco screening and cessation intervention (11.8 pp; 95% CI, 3.7-20.0 pp), and depression screening and follow-up (8.9 pp; 95% CI, 0.5-17.4 pp). No associations were observed between FQHC inclusion and utilization or expenditure.

CONCLUSIONS AND RELEVANCE: In this repeated cross-sectional study, MSSP ACOs with FQHC participation served more socioeconomically disadvantaged Medicare beneficiaries than those without FQHC participation. The inclusion of first FQHCs was associated with increased rates of several preventive services without increasing costs. Participation of safety net practices appeared to improve access to ACOs among beneficiaries from underserved communities.

PMID:39556394 | DOI:10.1001/jamanetworkopen.2024.45536

JAMA Netw Open. 2024 Nov 4;7(11):e2445543. doi: 10.1001/jamanetworkopen.2024.45543.

ABSTRACT

IMPORTANCE: Little is known about the epidemiology of out-of-hospital cardiac arrest (OHCA) in patients with asystole in countries where prehospital resuscitation is not withheld or terminated.

OBJECTIVE: To investigate the secular trends in the patient outcomes and advanced life support (ALS) procedures and evaluate the association of ALS procedures with favorable outcomes among patients with OHCA and asystole.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data from a nationwide prospective OHCA registry in Japan. OHCA occurred from June 1, 2014, to December 31, 2020. Adults with an initial rhythm of asystole and OHCA were included in the analysis, which was conducted between July 29, 2022, and August 24, 2024.

EXPOSURES: Year of OHCA and prehospital ALS procedures (advanced airway management [AAM] and intravenous epinephrine administration).

MAIN OUTCOMES AND MEASURES: Trends in prehospital and in-hospital ALS procedures and patient outcomes were described using the Jonckheere-Terpstra trend test for continuous variables and the Cochran-Armitage trend test for categorical variables. The primary outcome was a favorable neurological outcome at 30 days. The secondary outcomes included a favorable neurological outcome at 90 days and survival at 30 and 90 days. Associations between prehospital procedures and outcomes were analyzed using time-dependent propensity score and risk-set matching.

RESULTS: Of 60 349 patients with OHCA, 35 843 (59.4%) presented with asystole (median age, 77 [IQR, 64-85] years; 20 573 [57.4%] men). Among these, 33 674 patients (93.9%) underwent ALS procedures, with 67 (0.2%) achieving a favorable neurological outcome at 30 days. No significant trends in the outcomes were noted, except for a decline in return of spontaneous circulation (424 of 1848 [22.9%] to 1178 of 5892 [20.0%]; P = .003). Neither AAM (odds ratio [OR], 1.27 [95% CI, 0.76-2.12]; P = .36) nor intravenous epinephrine administration (OR, 0.53 [95% CI, 0.24-1.13]; P = .10) was associated with a favorable neurological outcome at 30 days, although both were associated with survival at 30 days (ORs, 1.45 [95% CI, 1.21-1.74] and 1.81 [95% CI, 1.44-2.27], respectively; P < .001 for both).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with OHCA presenting with asystole, the proportion with a favorable neurological outcome at 30 days was substantially low, and no prehospital ALS procedure was associated with a favorable neurological outcome. These findings suggest that discussions regarding implementation of a termination of resuscitation rule for such patients are warranted.

PMID:39556393 | DOI:10.1001/jamanetworkopen.2024.45543

Neuropsychology. 2024 Nov 18. doi: 10.1037/neu0000983. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate associations of executive function (EF) performance in adolescence with dimensional symptoms of inattention and hyperactivity-impulsivity assessed by multiple informants as well as ADHD (attention-deficit/hyperactivity disorder) symptoms based on the Diagnostic and Statistical Manual of Mental Disorders criteria, and whether familial factors and co-occurring symptoms of depressive disorder and conduct disorder explain these associations in a population-based sample.

METHOD: In 14-year-old twins from the population-based FinnTwin12 study (N = 638-1,227), we assessed EF with commonly used neuropsychological tests. Diagnostic and Statistical Manual of Mental Disorders symptoms of ADHD and psychiatric disorders were assessed with a semistructured interview, and dimensional symptoms of inattention and hyperactivity-impulsivity with behavioral ratings made by the twins, their co-twins, and teachers at age 14, and by parents and teachers at age 12, the latter being different from those at age 14.

RESULTS: Teacher-rated inattention had the strongest association with poorer EF performance across two measurement points with different teachers; these associations were not affected by adding symptoms of depressive disorder and conduct disorder as covariates. Within-pair analyses suggested that the associations of inattention and hyperactivity-impulsivity with EF were partly explained by familial factors.

CONCLUSION: Even at a subclinical level in a sample of adolescents representing general population, ADHD symptoms are associated with EF performance. Teachers’ evaluations appear especially valuable when assessing adolescents’ ADHD symptoms. Our findings support the notion of dimensional ADHD symptoms in the population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556384 | DOI:10.1037/neu0000983

Cancer Control. 2024 Jan-Dec;31:10732748241302427. doi: 10.1177/10732748241302427.

ABSTRACT

Effective cancer screening is essential for early detection and improved survival outcomes. Cancer is a leading cause of death for Hispanics/Latinx, who represent the largest minority group in the U.S. Despite lower tobacco use, lung cancer is the leading cause of cancer death in Hispanic/Latinx men and the second leading cause in women. Late-stage diagnoses, due to limited screening opportunities, contribute to poor survival rates. Cancer survivors, especially those previously diagnosed with head and neck cancer, face a significantly increased risk of developing lung cancer. Approximately one-fourth of head and neck cancer survivors die from a second malignancy, with lung cancer accounting for over half of these cases. These individuals are nearly three times more likely to develop lung cancer compared to the general population of smokers. In this manuscript, we detail the importance of implementing lung cancer screening in these high-risk populations.

PMID:39556362 | DOI:10.1177/10732748241302427

Personal Disord. 2024 Nov 18. doi: 10.1037/per0000707. Online ahead of print.

ABSTRACT

Disinhibition is a personality trait with broad health implications and has been included in several prominent models of maladaptive personality traits and psychopathology, such as the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Alternative Model of Personality Disorders and the Hierarchical Taxonomy of Psychopathology. Cross-sectional global self-report and clinical interview research suggests that disinhibition is tightly linked with interpersonal problems, particularly antagonistic problems. However, very little work has examined how individual differences in disinhibition manifest in interpersonal functioning in social situations in daily life. We examined how trait disinhibition and its lower level facets (e.g., irresponsibility, impulsivity, distractibility) relate to ecological momentary assessments of interpersonal interactions in daily life across three samples (total person N = 1,068, total observation N = 38,212). Results showed a consistent and positive association between trait disinhibition and negative affect in daily life (both in general and specifically during social interactions), above and beyond the effect of trait antagonism. We also found a negative association between trait disinhibition and warmth during social interactions, though this effect was fully accounted for by trait antagonism. We did not find consistent associations between trait disinhibition and positive affect or dominance in daily life. These findings have implications for the manifestation of disinhibition in daily life and the relation between externalizing and internalizing psychopathology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PMID:39556354 | DOI:10.1037/per0000707

JAMA Intern Med. 2024 Nov 18. doi: 10.1001/jamainternmed.2024.5981. Online ahead of print.

ABSTRACT

IMPORTANCE: Hyponatremia treatment guidelines recommend limiting the correction of severe hyponatremia during the first 24 hours to prevent osmotic demyelination syndrome (ODS). Recent evidence suggests that slower rates of correction are associated with increased mortality.

OBJECTIVE: To evaluate the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.

DATA SOURCES: We searched MEDLINE, Embase, the Cochrane Library, LILACS, Web of Science, CINAHL, and international congress proceedings for studies published between January 2013 and October 2023.

STUDY SELECTION: Comparative studies assessing rapid (≥8-10 mEq/L per 24 hours) vs slow (<8 or 6-10 mEq/L per 24 hours) and very slow (<4-6 mEq/L per 24 hours) correction of severe hyponatremia (serum sodium <120 mEq/L or <125 mEq/L plus severe symptoms) in hospitalized patients.

DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers (N.A.F., J.R.M., J.M.A., A.C.) independently reviewed studies, extracted data, and assessed each included study’s risk of bias using ROBINS-I. Cochrane methods, PRISMA reporting guidelines, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate the certainty of evidence were followed. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES: Primary outcomes were in-hospital and 30-day mortality, and secondary outcomes were hospital length of stay (LOS) and ODS.

RESULTS: Sixteen cohort studies involving a total of 11 811 patients with severe hyponatremia were included (mean [SD] age, 68.22 [6.88] years; 56.7% female across 15 studies reporting sex). Moderate-certainty evidence showed that rapid correction was associated with 32 (odds ratio, 0.67; 95% CI, 0.55-0.82) and 221 (odds ratio, 0.29; 95% CI, 0.11-0.79) fewer in-hospital deaths per 1000 treated patients compared with slow and very slow correction, respectively. Low-certainty evidence suggested that rapid correction was associated with 61 (risk ratio, 0.55; 95% CI, 0.45-0.67) and 134 (risk ratio, 0.35; 95% CI, 0.28-0.44) fewer deaths per 1000 treated patients at 30 days and with a reduction in LOS of 1.20 (95% CI, 0.51-1.89) and 3.09 (95% CI, 1.21-4.94) days, compared with slow and very slow correction, respectively. Rapid correction was not associated with a statistically significant increased risk of ODS.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, slow correction and very slow correction of severe hyponatremia were associated with an increased risk of mortality and hospital LOS compared to rapid correction.

PMID:39556338 | DOI:10.1001/jamainternmed.2024.5981

Epilepsia. 2024 Nov;65(11):3324-3334. doi: 10.1111/epi.18118. Epub 2024 Sep 18.

ABSTRACT

OBJECTIVE: Phenotypic heterogeneity presents challenges in providing clinical care to patients with pathogenic SCN8A variants, which underly a wide disease spectrum ranging from neurodevelopmental delays without seizures to a continuum of mild to severe developmental and epileptic encephalopathies (DEEs). An important unanswered question is whether there are clinically important subgroups within this wide spectrum. Using both supervised and unsupervised machine learning (ML) approaches, we previously found statistical support for two and three subgroups associated with loss- and gain- of- function vari-ants, respectively. Here, we test the hypothesis that the unsupervised subgroups (U1-U3) are distinguished by differential contributions of developmental and epileptic components.

METHODS: We predicted that patients in the U1 and U2 subgroups would differ in timing of developmental delay and seizure onset, with earlier and concurrent onset of both features for the U3 subgroup. Standard statistical procedures were used to test these predictions, as well as to investigate clinically relevant associations among all five subgroups.

RESULTS: Two-population proportion and Kruskal-Wallis tests supported the hypothesis of a reversed order of developmental delay and seizure onset for patients in U1 and U2, and nearly synchronous developmental delay/seizure onset for the U3 (termed DEE) subgroup. Association testing identified subgroup variation in treatment response, frequency of initial seizure type, and comorbidities, as well as different median ages of developmental delay onset for all five subgroups.

SIGNIFICANCE: Unsupervised ML approaches discern differential developmental and epileptic components among patients with SCN8A-related epilepsy. Patients in U1 (termed developmental encephalopathy) typically gain seizure control yet rarely experience improvements in development, whereas those in U2 (termed epileptic encephalopathy) have fewer if any developmental impairments despite difficulty in achieving seizure control. This understanding improves prognosis and clinical management and provides a framework to discover mechanisms underlying variability in clinical outcome of patients with SCN8A-related disorders.

PMID:39556335 | DOI:10.1111/epi.18118

Egypt Heart J. 2024 Nov 18;76(1):151. doi: 10.1186/s43044-024-00578-z.

ABSTRACT

BACKGROUND: Myocardial deformation by speckle tracking echocardiography provides valuable information on the left ventricular function. The study aims to assess myocardial deformation in terms of left ventricular strain as an indicator of myocardial function in children after cardiac surgery at outpatient follow-up visits.

METHODS: The study design was a prospective observational cross-sectional study that included pediatric patients after biventricular cardiac surgery during the postoperative follow-up visits in the outpatient department. In addition to conventional echocardiographic examination, two-dimensional speckle tracking echocardiography was done to evaluate myocardial deformation in terms of left ventricular strain. Echocardiographic measurements were done offline and were compared to published reference normal values for age. Study subjects were divided according to age at follow-up into four groups (1 month-1 year, 1-2 years, 2-5 years, and 5-11 years).

RESULTS: Over ten months, 100 patients (64 males and 36 females) were included in the study. The median age was 30.8 months (IQR 12.8-65.3 months), the median weight was 11.7 kg (IQR 8-17 kg) and the median duration after surgery was 7.3 months (IQR 3.2-30.8 months). Longitudinal strain values were significantly (p < 0.001) lower than reference values for different age groups. Global circumferential strain showed no significant difference from the reference values. The duration after surgery had a statistically significant effect on longitudinal strain values, with improvement of the strain values with increasing intervals after surgery.

CONCLUSION: Using myocardial deformation method to evaluate cardiac function may detect underlying cardiac function abnormalities even with normal traditional functional parameters, which could have implications for patient management and follow-up.

PMID:39556306 | DOI:10.1186/s43044-024-00578-z