Tag: nevin manimala

Int J Gynaecol Obstet. 2025 Apr 8. doi: 10.1002/ijgo.70062. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the prevalence of cognitive dysfunction and associated behavioral changes and their prevalence among postpartum women, and also the prevalence of lactational failure and its determinants among postpartum women.

METHODS: A cross-sectional study was conducted involving 200 postpartum women (65% rural, 35% urban). Data were collected through structured interviews and assessments using the Indian version of the Montreal Cognitive Assessment and Depression, Anxiety, and Stress Scale-21. Statistical analyses included chi-square tests and regression models.

RESULTS: Cognitive dysfunction was observed in 25% of participants (21.5% mild, 3.5% moderate). Stress, anxiety, and depression were prevalent in 80.5%, 27%, and 30% of women, respectively. Lactational failure was reported by 21%, strongly correlated with cognitive dysfunction (P = 0.01) and mental health issues (stress, anxiety, and depression; P < 0.001). Key determinants of lactational failure included poor mother-partner relationships, lack of social support, low education levels, delayed breastfeeding initiation, childcare stress, comorbidities, mode of delivery, and low birth weight. Cognitive dysfunction was significantly associated with male offspring, insufficient milk production, lack of social support, and poor education levels (P < 0.001).

CONCLUSION: The study highlights a strong association between maternal mental health, cognitive dysfunction, and lactational failure. Addressing psychosocial and demographic determinants through targeted interventions is critical for improving maternal and child health outcomes in postpartum populations.

PMID:40198117 | DOI:10.1002/ijgo.70062

Ann Am Thorac Soc. 2025 Apr 8. doi: 10.1513/AnnalsATS.202411-1174OC. Online ahead of print.

ABSTRACT

RATIONALE: Persistent critical illness (PerCI) is costly, rising in incidence, and not reliably predicted with existing risk-prediction tools.

OBJECTIVE: To assess whether attending intensivists can identify patients at heightened risk of developing PerCI.

METHODS: We conducted a prospective longitudinal assessment from August 2020 to January 2023. Intensivists were assessed on each patient within 24 hours of admission to the medical intensive care unit (ICU) and on ICU day three. We measured intensivists’ prognostication of within-ICU events (late-onset shock and/or acute hypoxic respiratory failure [AHRF] and PerCI) and self-rated confidence in prognostications. Test characteristics were calculated for both outcomes, at each timepoint, and stratified by self-rated confidence.

RESULTS: 1,295 assessments were completed (response rate: 87.9%), assessing 875 ICU admissions by 18 intensivists. Late-onset shock/AHRF and PerCI occurred in 7.3% and 16.0% of ICU admissions, respectively. C-statistics for intensivist prognostication of late-onset shock/AHRF were 0.5 (95%CI:0.5-0.6) and 0.6 (95%CI:0.5-0.6) on admission and day three, respectively. C-statistics for PerCI were 0.7 (95%CI:0.7-0.7) and 0.7 (95%CI:0.7-0.8), respectively. C-statistics for late-onset shock/AHRF were no different for confident vs unconfident assessments. C-statistics for PerCI were higher for confident vs unconfident assessments (0.8 vs 0.6, p<0.01) on admission, but not different on day three (0.7 vs 0.7, p=0.20).

CONCLUSIONS: Intensivist prognostications have poor discriminatory accuracy for the development of late-onset shock/AHRF and moderate accuracy for development of PerCI. Further research is needed to understand what factors influence intensivists’ prognostications of within-ICU deterioration and how this information is conveyed to patients and families.

PMID:40198113 | DOI:10.1513/AnnalsATS.202411-1174OC

Int J Oral Maxillofac Implants. 2025 Apr 8;40(2):197-206. doi: 10.11607/jomi.11004.

ABSTRACT

PURPOSE: To compare survival rates and the marginal bone loss (MBL) of implants placed in patients with one-stage or two-stage maxillary sinus augmentation via the lateral window approach (MSALW) using only deproteinized bovine bone mineral (DBBM).

MATERIALS AND METHODS: The dental records and radiologic data of patients who had implants placed with MSALW were collected. The patients were divided according to the one-stage and two-stage MSALW, and the survival rate of each group was measured using the Kaplan-Meier method. The MBL of each group was measured through periapical radiographs at each defined time period. Statistical analysis of the differences between groups was conducted through the log-rank test and one-way analysis of variance (ANOVA). Univariate and multivariate regression tests wereperformed to analyze the degree of influence the interested variables had on the implant survival rate.

RESULTS: There was no significant difference in the 5-year cumulative survival rates between the one-stage and two-stage MSALW at the implant level (91.0% and 90.6%, respectively; P = .201) or at the patient level (89.7% and 89.7%, respectively; P = .330). There was a slight difference in MBL at the initial time point, but there was no significant difference for the total period (P = .289). Diabetes was found to have a negative effect on implant survival (P = .015; hazard ratio [HR] = 3.669).

CONCLUSIONS: There was no significant difference in the 5-year cumulative survival rate or the 2-year MBL of implants between the one-stage and two-stage MSALW using DBBM.

PMID:40198091 | DOI:10.11607/jomi.11004

JAMA Netw Open. 2025 Apr 1;8(4):e253443. doi: 10.1001/jamanetworkopen.2025.3443.

ABSTRACT

IMPORTANCE: Understanding the reciprocal association between post-intensive care syndrome (PICS) and caregiver burden is crucial for optimal care of patients and caregivers following critical illness.

OBJECTIVE: To evaluate the associations between patient post-intensive care impairments and caregiver burden.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of the MIND-USA study, a multicenter randomized clinical trial, which enrolled patients admitted to intensive care units (ICU) from 16 academic medical centers across the US (December 2011 to August 2017), included 148 patient-caregiver dyads. Patients were adults aged 18 years or older with ICU delirium randomized to receive haloperidol, ziprasidone, or placebo. A caregiver who provided unpaid assistance to the patient was identified at enrollment. PICS and caregiver burden were assessed at 3 months and 12 months after randomization. Statistical analysis was performed from March 2023 to April 2024.

MAIN OUTCOMES AND MEASURES: ICU survivors were assessed for PICS domains, including physical and cognitive function, and posttraumatic stress disorder using the Katz Activities of Daily Living, the Functional Activities Questionnaire, the Telephone Interview for Cognitive Status, and the Posttraumatic Stress Disorder Checklist-Civilian version, respectively. Caregiver burden was assessed using the Zarit Burden Interview. The associations between patient PICS and caregiver burden at 3 and 12 months were examined using structural equation modeling.

RESULTS: Of 148 patients included in this study with a median (IQR) age of 58 (48-65) years, the majority identified as male (79 patients [53.4%]), and there were 16 (10.8%) Black, 139 (93.9%) non-Hispanic, and 127 (85.8%) White patients. PICS and caregiver burden at 3-month follow-up was positively associated with these outcomes at 12-month follow-up (PICS: β = 0.69; 95% CI, 0.50 to 0.88; P < .001; caregiver burden: β = 0.68; 95% CI, 0.53 to 0.82; P < .001). However, contrary to the study hypotheses, significant associations between 3-month PICS and 12-month caregiver burden and between 3-month caregiver burden and 12-month PICS were not observed (PICS→caregiver burden: β = 0.82; 95% CI, -0.02 to 1.66; P = .09; caregiver burden→PICS: β = 0.00; 95% CI, -0.03 to 0.03; P = .95). There was significant covariance between PICS and caregiver burden at each time point.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial of ICU survivors and their caregivers, patient PICS and caregiver burden were associated at concurrent time points but were not associated with each other longitudinally.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01211522.

PMID:40198074 | DOI:10.1001/jamanetworkopen.2025.3443

JAMA Netw Open. 2025 Apr 1;8(4):e253698. doi: 10.1001/jamanetworkopen.2025.3698.

ABSTRACT

IMPORTANCE: There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA).

OBJECTIVE: To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA.

DESIGN, SETTING, AND PARTICIPANTS: This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024.

INTERVENTIONS: Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24.

MAIN OUTCOMES AND MEASURES: The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International-Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life-8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire-9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle.

RESULTS: In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was -1.1 mm (95% CI, -7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (-44.5 mm [95% CI, -70.7 to -18.3 mm]), WOMAC function (-139 mm [95% CI, -228.3 to -49.7 mm]), WOMAC stiffness (-17.6 mm [95% CI, -30.9 to -4.3 mm]), patient global assessment (-7.6 mm [95% CI, -15.1 to -0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, -1.1 [95% CI, -1.9 to -0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild.

CONCLUSION AND RELEVANCE: In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA.

TRIAL REGISTRATION: ANZCTR.org Identifier: ACTRN12621000066886.

PMID:40198073 | DOI:10.1001/jamanetworkopen.2025.3698

JAMA Netw Open. 2025 Apr 1;8(4):e254026. doi: 10.1001/jamanetworkopen.2025.4026.

ABSTRACT

IMPORTANCE: Identifying whether people of minoritized religious identities are less likely to benefit from psychological therapy is key to tackling inequalities in mental health treatment.

OBJECTIVE: To assess inequalities in the effectiveness of routinely delivered psychological therapy across religious groups and by the intersections with ethnicity.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study including all patients who completed a course of treatment at 5 London-based National Health Service Talking Therapies for anxiety and depression (NHS TTad) services between 2011 and 2020. Individuals reported their religion using routine patient records collected by the services. Data were analyzed from September 2023 to October 2024.

EXPOSURES: Self-identified religion was categorized into (1) no religion, (2) Christian, (3) Muslim, and (4) other (which was further categorized into Buddhist, Hindu, Jewish, Sikh, and any other in a sensitivity analysis). Ethnicity was conceptualized as a potential confounder and separately as an effect modifier. Self-reported ethnicity was categorized based on UK Census codes into Asian, Black, mixed race, White, and other ethnic groups.

MAIN OUTCOMES AND MEASURES: Psychological treatment outcomes used to assess NHS TTad services nationally, including reliable recovery, recovery, and reliable deterioration. Dropout from treatment was also examined. These outcomes were defined based on pre-post treatment changes in depression and anxiety symptom measures according to national guidelines.

RESULTS: A total of 70 098 patients with data on self-reported religion were included in the study (mean [SD] age at referral, 39.2 [14.1] years; 47 797 [68.2%] female). After adjusting for sociodemographic, treatment-related, and clinical characteristics, the odds of reliable recovery were higher in patients who did not have any religious belief (odds ratio [OR], 1.34; 95% CI, 1.26-1.42) or self-reported Christian (OR, 1.39; 95% CI, 1.31-1.48) and other religion (OR, 1.25; 95% CI, 1.17-1.34) compared with Muslim patients. While treatment outcomes improved each year in all groups, Muslim patients remained least likely to improve and more likely to deteriorate. There were interactions between religion and ethnicity; in particular, Muslim patients of White or other ethnic backgrounds had worse outcomes than Muslim patients of Asian, Black, or mixed race ethnic backgrounds and compared with non-Muslim patients of those ethnicities.

CONCLUSIONS AND RELEVANCE: In England, patients who identified as Muslim, and particularly those of White or other ethnicities, had poorer outcomes from psychological therapies for depression and anxiety disorders than patients who reported no religion or any other religion. This may be partly due to unmeasured characteristics that warrant further investigation (eg, nationality and asylum-seeking or refugee status). Best practice guidelines on working with people of minoritized ethnicities may inform some of the changes needed to reduce inequalities, but must address religious identity separate from ethnicity, as well as their intersections.

PMID:40198069 | DOI:10.1001/jamanetworkopen.2025.4026

JAMA Netw Open. 2025 Apr 1;8(4):e254074. doi: 10.1001/jamanetworkopen.2025.4074.

ABSTRACT

IMPORTANCE: Posthospital inpatient rehabilitation is essential for many patients with traumatic injuries. However, rehabilitation centers lack transparency and oversight in their admission practices and may be influenced by health care practitioner (HCP) use of stigmatizing language in patient medical records, leading to inequities in access to care.

OBJECTIVES: To examine differences in admission to inpatient rehabilitation centers for patients hospitalized for violent penetrating (VP) injuries compared with motor vehicle crash (MVC) injuries.

DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods retrospective qualitative study used data obtained from hospital records from 2015 to 2021. Data analysis occurred between July and December 2023. The study was performed at Boston Medical Center, an urban level I trauma center. The cohort included all patients hospitalized for VP or MVC injuries who were discharged to an inpatient rehabilitation center between 2015 and 2021.

EXPOSURES: Injury type, categorized as VP or MVC.

MAIN OUTCOMES AND MEASURES: The primary quantitative outcome was a denial for admission to an inpatient rehabilitation center. Qualitative content analysis identified similarities and differences across injury types in the manifestations of predetermined stigmatizing language categories in patients’ medical records.

RESULTS: Of 323 patients discharged to an inpatient rehabilitation center (median [IQR] age, 38 [25-59] years; 208 men [64.4%]; 29 Hispanic patients [9.0%], 118 non-Hispanic Black patients [36.5%], and 152 non-Hispanic White patients [47.1%]), 107 patients (33.1%) experienced at least 1 denial by a center before being placed (32 of 55 patients with VP injuries [58.2%] vs 75 of 268 patients with MVC injuries [28.0%]). Compared with patients with MVC injuries, patients with VP injuries had greater than 3 times the odds of experiencing a denial (odds ratio, 3.51; 95% CI, 1.93-6.48; P < .001). Medical records of patients with VP injuries had increased use of stigmatizing language that indicated culturally based or injury-related stereotyping, skepticism toward patient-reported symptoms, and heightened HCP-power dynamics contributing to unilateral decision-making.

CONCLUSIONS AND RELEVANCE: In this mixed-methods qualitative study of hospital patients discharged to rehabilitation centers, significant disparities in denials for admission were observed among survivors of violence, who were disproportionally Black or Hispanic. Stigmatizing language found in medical records suggested that bias within the referral process may have contributed to these disparities. These findings underscore the need for reformed clinical documentation practices and enhanced oversight of rehabilitation referral processes to promote equitable access to care.

PMID:40198068 | DOI:10.1001/jamanetworkopen.2025.4074

JAMA Netw Open. 2025 Apr 1;8(4):e254111. doi: 10.1001/jamanetworkopen.2025.4111.

ABSTRACT

IMPORTANCE: Extreme weather events disproportionately affect vulnerable populations, particularly nursing home residents. In February 2021, Winter Storm Uri caused unprecedented power outages and water shortages across Texas. However, its impact on nursing home residents remains poorly understood.

OBJECTIVE: To assess the association of power outages and water shortages during Winter Storm Uri with mortality and health care utilization among long-stay nursing home residents in Texas.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of long-stay nursing home residents before and after Winter Storm Uri (February 14 to February 17, 2021) in Texas. Data analysis was conducted from March 2024 to January 2025.

EXPOSURE: Residing in a nursing home that experienced a power outage or water shortage during Winter Storm Uri.

MAIN OUTCOMES AND MEASURES: The outcome measures were weekly rates of mortality, clinician visits to nursing homes, emergency department (ED) visits, and hospitalizations among long-stay nursing home residents. Medicare claims were used to determine weekly mortality, clinician visits, ED visits, and hospitalizations 6 weeks before and 6 weeks after the storm. Differences-in-differences (DiD) analysis using 2-level logistic regression models estimated changes in outcomes associated with nursing home power or water loss.

RESULTS: Of 1174 nursing homes, 231 (19.7%) reported power or water outages. The sample included 45 439 long-stay residents, with 8521 in facilities with outages (mean [SD] age, 80.07 [12.21] years; 5664 female [66.47%]) and 36 918 in facilities without outages (mean [SD] age, 80.42 [11.92] years; 12 705 female [65.59%]). DiD analysis found that residents of nursing homes with outages had a 0.13% (95% CI, 0.03% to 0.23%) higher mortality rate in the 3 to 5 weeks after the storm than those without outages. There were no significant differences in clinician visits (DiD, -0.31%; 95% CI, -1.08% to 0.47%), ED visits (DiD, 0.11%; 95% CI, -0.12% to 0.34%), or hospitalizations (DiD, 0.07%; 95% CI, -0.10% to 0.23%).

CONCLUSIONS AND RELEVANCE: In this cohort study of nursing home residents in Texas, power and water outages during Winter Storm Uri were associated with increased mortality but not ED visits or hospitalizations, highlighting the vulnerability of nursing home residents during extreme weather events.

PMID:40198067 | DOI:10.1001/jamanetworkopen.2025.4111

J Sci Food Agric. 2025 Apr 8. doi: 10.1002/jsfa.14277. Online ahead of print.

ABSTRACT

BACKGROUND: Lily bulbs are used as food and herbal medicine in the Chinese market. These are often sulfur-fumigated during postharvest processing for bleaching and preservation. This study aimed to compare the volatile compounds in non-fumigation and sulfur-fumigation lily bulbs by headspace solid-phase microextraction (HS-SPME) coupled with gas chromatography-mass spectrometry (GC-MS) detection and multivariate statistical analysis.

RESULTS: The results showed that sulfur fumigation led to the chemical transformation of certain original components and significantly changed the chemical characteristics of lily bulbs. A total of 56 volatile compounds were identified in the 12 samples, including one non-fumigated and 11 sulfur-fumigated lily bulbs. Based on multivariate statistical analysis, 13 most characteristic chemical markers were selected to distinguish non-fumigated and sulfur-fumigated lily bulbs. Moreover, the transformation mechanism of the four sulfur compounds and several chemical markers was inferred, which showed that an addition reaction and rearrangement reaction most occurred in the process of sulfur fumigation.

CONCLUSION: This newly proposed approach can be applied to ensure consistent quality associated with sulfur fumigation for lily bulbs and other food products. © 2025 Society of Chemical Industry.

PMID:40196924 | DOI:10.1002/jsfa.14277

J Cachexia Sarcopenia Muscle. 2025 Apr;16(2):e13793. doi: 10.1002/jcsm.13793.

ABSTRACT

BACKGROUND: Multiple myeloma (MM) is the second most common haematological malignancy. The predominantly older patients often suffer from comorbidities that impair their quality of life (QoL). Physical activity (PA) can be beneficial for cancer patients, but less evidence exists in MM. This randomized controlled trial (RCT) compared an exercise group with World Health Organization (WHO)-compliant PA (150 min aerobic exercise and 2 resistance training-sessions/week) vs. activity as usual (control group).

METHODS: Thirty-four newly diagnosed consecutive MM patients were randomized 1:1 to exercise vs. control groups. Guided training (2×/week) was performed for 3 months during bortezomib-cyclophosphamide-dexamethasone (VCd) induction. PA was monitored using smartwatches and diaries. Demographics, osteolytic lesions, infections, fatigue, depression, and biomarkers (albumin, creatine kinase, C-reactive protein, high-density lipoprotein, low-density lipoprotein and pro-brain natriuretic peptide) were compared in exercise vs. control cohorts. VCd-tolerance, response, ‘timed-up-and-go-test’ (TUGT), Revised Myeloma Comorbidity Index (R-MCI), QoL (SF-12 questionnaire), event-free survival and trainer assignment during the training period were assessed (13 tests at baseline, during VCd and end of treatment [EOT]).

RESULTS: The exercise group was more than twice as active as the control group, with an average aerobic activity of 162 versus 68 min/week, respectively. Trainer-guided muscle-strengthening exercises were performed 2×/week in the exercise group, in line with WHO recommendations. These data were monitored via smartwatches and training diaries. PA proved to be safe: No exercise-related SAEs or accidents occurred. The study adherence was 94% (32/34). In the exercise versus control group, AEs to VCd induction (6% vs. 25%), therapy intolerance (6% vs. 25%) and hospitalization (31% vs. 50%, respectively) occurred less frequently. VCd-dose adjustments in the exercise vs. control group were significantly less needed (6.3% vs. 37.5%, respectively). At EOT, patients in the exercise group showed less fatigue (6% vs. 75%), less depression (6% vs. 44%), better TUGT (6 vs. 11 s, respectively), improved R-MCI and QoL compared to the control group. Grip strength (right hand: 73-82 lb; left hand: 68-72 lb) significantly improved from baseline to EOT in the exercise group. Biomarkers did not significantly differ in both groups, but response to VCd-induction and event-free survival were improved in the exercise group, however, without reaching statistical significance.

CONCLUSIONS: PA in MM patients during induction is feasible and can improve fatigue, depression, TUGT, grip strength, comorbidities and QoL. More sport intervention offers are warranted to advance exercising in MM.

TRIAL REGISTRATION: drks.de: DRKS00022250.

PMID:40196920 | DOI:10.1002/jcsm.13793