Tag: nevin manimala

JAMA Netw Open. 2025 Mar 3;8(3):e251122. doi: 10.1001/jamanetworkopen.2025.1122.

ABSTRACT

IMPORTANCE: Children with growth faltering are more susceptible to infections and may experience cognitive, physical, and metabolic developmental impairments.

OBJECTIVE: To assess whether prenatal and preconception meteorological and environmental factors are associated with village-level rates of childhood growth outcomes in Uganda.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data collected between June 20, 2015, and December 16, 2016, from the 2016 Ugandan Demographic and Health Survey for individuals aged 0 to 59 months with available anthropometric measures (weight and length or height). Data analysis was conducted from October 2020 to April 2024.

EXPOSURES: Factors assessed included meteorological information, such as drought index (Standardized Precipitation-Evapotranspiration Index [SPEI]), Aridity Index, rainfall, temperature, and vegetation indices; demographic and economic development factors (nighttime light emissions, driving time to the nearest city); and land topography (slope angle, elevation above sea level).

MAIN OUTCOMES AND MEASURES: The main outcomes were height-for-age z score (HAZ), weight-for-age z score (WAZ), and weight-for-height z score (WHZ). Spatial resolution estimates, at 1 km × 1 km of childhood growth faltering indicators, were created.

RESULTS: Of the 5219 individuals aged 0 to 59 months included in the analysis, 2633 (50%) were female; mean (SD) age was 29 (17) months. Of these individuals, 30.22% (95% CI, 29.36%-30.98%) had stunting, 12.23% (95% CI, 11.55%-12.91%) had underweight, and 3.63% (95% CI, 3.46%-3.80%) had wasting. Large disparities in the burden of childhood growth faltering existed within Uganda at smaller and larger spatial scales; villages in the northeastern and southwestern areas of the country had the highest prevalence of all forms of growth faltering (stunting, >40%; underweight, >16%; and wasting, >6%). Higher SPEI at 3 months before birth was positively associated with all childhood growth outcomes: HAZ (β, 0.06; 95% CI, 0.02-0.10), WAZ (β, 0.04; 95% CI, 0.01-0.07), and WHZ (β, 0.03; 95% CI, 0.001-0.06). Higher location mean rainfall 11 months before birth was also positively associated with HAZ (β, 0.06; 95% CI, 0.01-0.10). Aridity Index associations with WAZ (β, 0.09; 95% CI, 0.04-0.13) and WHZ (β, 0.09; 95% CI, 0.02-0.16) were consistent with findings for SPEI.

CONCLUSIONS AND RELEVANCE: In this study of 5219 individuals 0 to 59 months of age in Uganda, rainfall and long-term availability of water at preconception and during gestation were positively associated with nutritional child growth outcomes. Understanding the relative contributions of meteorological environment factors on the spatial distribution of undernutrition at various spatial scales within Uganda (from the village to the district level) may help in the design of more cost-effective delivery of precision public health programs.

PMID:40105840 | DOI:10.1001/jamanetworkopen.2025.1122

JAMA Netw Open. 2025 Mar 3;8(3):e251152. doi: 10.1001/jamanetworkopen.2025.1152.

ABSTRACT

IMPORTANCE: Indefinite suppressive antibiotic therapy (SAT) is sometimes prescribed after initial antibiotic treatment for prosthetic joint infection (PJI). Limited evidence on outcomes after SAT exists, and using SAT for patients at low risk who may not need it could be associated with antibiotic resistance and adverse events.

OBJECTIVES: To characterize clinical decision-making about SAT after PJI and identify stewardship intervention opportunities to stop or reduce SAT for patients who may not benefit.

DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, interviews were conducted with 41 clinicians involved in decision-making about SAT after PJI at 8 US Veterans Affairs hospitals between November 1, 2019, and July 31, 2021. Analysis was conducted from June 9, 2020, to August 31, 2022.

MAIN OUTCOMES AND MEASURES: Systematic thematic analysis of transcripts of semistructured interviews was conducted to assess the decision-making process for SAT after PJI, including identifying decision-makers, risks and benefits of SAT, and significant time points that occur before or after the SAT prescribing decision.

RESULTS: A total of 41 clinicians were interviewed. Interviewees reported a complex, usually patient-specific, sometimes collaborative decision-making process. Decisions were emotionally charged because of serious possible repercussions for patients and limited evidence about benefits and risks associated with SAT. Surgeons and infectious diseases physicians were the primary SAT prescribers. Their initial risk-benefit calculation for SAT usually included whether revision surgery could be performed and what type, the organism, patient factors, and clinical signs of infection, as well as their perception of the existing evidence base for SAT after PJI. Interviewees identified significant time points that occured before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Other potential decision-makers over time included patients, primary care physicians, and pharmacists. Interviewees identified opportunities to discuss SAT-associated benefits and risks with patients as well as other clinicians. Interviewees wanted more evidence about patient outcomes to inform prescribing decisions and emphasized the importance of clinician autonomy and buy-in for practice change.

CONCLUSIONS AND RELEVANCE: This qualitative study found that surgeons and infectious diseases physicians often made initial decisions about SAT and identified other potential decision-makers (patients, primary care physicians, pharmacists) and significant time points that occur before or after the SAT prescribing decision, including PJI treatment decisions and follow-up appointments. Stewardship interventions should take into account decision points for patients with PJI across time and the range of decision-makers, including patients, across time.

PMID:40105839 | DOI:10.1001/jamanetworkopen.2025.1152

JAMA Netw Open. 2025 Mar 3;8(3):e251158. doi: 10.1001/jamanetworkopen.2025.1158.

ABSTRACT

IMPORTANCE: Opioid-involved overdose mortality has been on the rise for 2 decades in the US, exacerbated by an unregulated drug supply that is unpredictable and has increasingly contained highly potent fentanyl analogs starting a decade ago.

OBJECTIVE: To determine whether there is a geospatial association between law enforcement drug seizures and opioid-involved overdose mortality in San Francisco.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used location- and time-stamped overdose mortality data from the Office of the Chief Medical Examiner and publicly available crime data from the San Francisco Police Department between 2020 and 2023 to assess whether location and time of law enforcement drug seizures were associated with subsequent opioid-involved overdose mortality. Data were analyzed from January 2020 to September 2023.

EXPOSURES: Time-stamped locations of law enforcement drug seizures involving a drug distribution charge.

MAIN OUTCOMES AND MEASURES: The primary outcomes were the time and location of (1) overdose mortality involving any opioid and (2) overdose mortality involving fentanyl or any fentanyl analog. The relative risk (RR) and 95% CIs for endemic and epidemic factors were calculated.

RESULTS: There were 2653 drug seizure crime events that involved any drug distribution charge and 1833 overdose deaths that tested positive for any opioid or synthetic opioid, including heroin and fentanyl analogs. Within the surrounding 100 meters, law enforcement drug seizures were associated with increase risk of fatal opioid-involved overdoses the day following the drug seizure event (RR, 1.74; 95% CI, 1.06-2.83; P = .03) and elevated risk persisted for 7 days (2 days: RR, 1.55; 95% CI, 1.09-2.21; P = .02; 3 days: RR, 1.45; 95% CI, 1.08-1.93; P = .01; 7 days: RR, 1.27; 95% CI, 1.11-1.46; P = .001). Similar statistically significant spatiotemporal patterns were observed in the 250- and 500-meter spatial bandwidths. Within each space-time kernel, the strength of the association, all of which were statistically significant, dissipated the further away in time and distance from the law enforcement drug seizure event.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality. To reduce overdose mortality, it may be better to focus on evidence-based health policies and interventions.

PMID:40105838 | DOI:10.1001/jamanetworkopen.2025.1158

JAMA Surg. 2025 Mar 19. doi: 10.1001/jamasurg.2025.0172. Online ahead of print.

NO ABSTRACT

PMID:40105828 | DOI:10.1001/jamasurg.2025.0172

Pain. 2025 Mar 18. doi: 10.1097/j.pain.0000000000003573. Online ahead of print.

ABSTRACT

This study investigates whether data from people with endometriosis (n = 58) and fibromyalgia (n = 58) exhibit what is called “ergodicity,” meaning that results from analyses of aggregated group data can be used to support conclusions about the individuals within the groups. The variables studied here are commonly investigated in chronic pain: pain intensity, pain interference, depressive symptoms, psychological flexibility, and pain catastrophizing. Data were collected twice daily for 42 days from each participant and analyzed in 2 ways: as separate cross-sectional group studies using the timepoints as the separate data sets (between-person) and as individual longitudinal studies using each person’s time series data (within person). To confirm ergodicity, the results from the 2 analyses should agree. However, this is not what was observed in several respects. The between-person data showed substantially less variability compared with within-person data. This was evident in both the summary statistics involving single variables and in the correlational analyses. Overall, between-person correlations were relatively restricted in range, while within-person correlations varied widely. These findings have potentially profound implications for the field of chronic pain research. Because ergodicity was not found, this raises doubts around the assumption that aggregated data collected from groups can accurately represent the range of individual experiences in chronic pain. These results advocate for a shift toward inclusion of more individual person-focused approaches as an addition to group-based approaches. This shift could lead to more personalized and effective treatments by better capturing and then clarifying the heterogeneous nature of chronic pain, including the processes that underlie it.

PMID:40105802 | DOI:10.1097/j.pain.0000000000003573

Eur J Prosthodont Restor Dent. 2025 Mar 12. doi: 10.1922/EJPRD_2790Fehrenbach07. Online ahead of print.

ABSTRACT

INTRODUCTION: Thin all-ceramic restorations enhance esthetics but are less predictable, especially with dark substrates, where opaque resin luting agents may be needed, though not always available. This study aimed to evaluate the influence of a resin luting agent on the final color of lithium disilicate crowns and masking of two prosthetic substrates (esthetic and metallic).

METHODS: Eighty prostheses with ceramic crowns were simulated from bovine roots. The specimens were randomized, according to the intraradicular retainer used, and divided into 2 groups (n=40): metallic (cast post and core) and esthetic (glass fiber post with composite resin core). The crowns were attached to their cores and the first CIELAB scale was measured with a spectrophotometer. The second color measurement was performed after cementation with a dual resin luting agent. The results were submitted to color variation calculation and statistical analysis.

RESULTS: Coordinate * L and * b values increased significantly (p⟨0.05) after cementation for both groups and there was no statistical difference between the groups for the ΔE00 value (p=0.242).

CONCLUSIONS: Resin luting agent positively impacted the final crown color and aided in masking both substrates. The effect of the substrate was attenuated on the final color of ceramic crowns.

PMID:40105749 | DOI:10.1922/EJPRD_2790Fehrenbach07

Clin J Pain. 2025 Mar 19. doi: 10.1097/AJP.0000000000001284. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify health professional’s perception of barriers, facilitators and training needs when working with children experiencing chronic pain.

METHODS: Cross-sectional online survey of health professionals working with children experiencing chronic pain. Survey questions were a range of exploratory open and closed-ended questions, which included yes/no responses, choosing from a list, ranking options and open responses. Quantitative data were analysed using descriptive statistics and percentages; qualitative data were analysed using content analysis.

RESULTS: 180 health professionals took part, of which 44% were physiotherapists. Tertiary hospitals and private practices were most common workplaces. The most frequently reported categories of both barriers and facilitators were workforce and system factors, child factors and parent factors. The most frequently reported confidence areas and development areas were health professional factors, approaches to care and team structure. 75% of participants reported they were moderately to extremely interested in further training in paediatric chronic pain management and indicated a preference for interactive training rather than “passive” learning formats.

DISCUSSION: Health professionals report a diverse range of perspectives when working with children experiencing chronic pain, including perceived barriers and facilitators to care. Most health professionals were interested in future training in paediatric chronic pain management. Future research exploring the parent and child perspective and how these factors present clinically is needed to inform future training opportunities for health professionals working with children experiencing chronic pain.

PMID:40105747 | DOI:10.1097/AJP.0000000000001284

Nicotine Tob Res. 2025 Mar 19:ntaf058. doi: 10.1093/ntr/ntaf058. Online ahead of print.

ABSTRACT

INTRODUCTION: Females have poorer smoking cessation outcomes than males, especially with nicotine replacement therapy (NRT) aided attempts, perhaps due to ovarian hormones. Additionally, Black adults experience higher rates of tobacco-related mortality and also experience important ovarian hormone differences. This is the first study to examine sex, age, and menopause differences in NRT-aided smoking cessation outcomes in an all-Black sample.

METHODS: A secondary-data analysis conducted on non-Hispanic Black adults aged 18+ who smoked 5-30 cigarettes/day for at least 6 months. Participants were categorized by sex assigned at birth (female versus male) and age (<45 versus ≥45 years) with females in the ≥45 age group restricted to those who were postmenopausal (defined as one year post menses per self-report). Smoking status two weeks post-quit date was assessed by cessation attempts, expired carbon monoxide-verified abstinence, and reduction in daily cigarettes. Statistical analyses utilized Mann-Whitney rank-sum tests, chi-square tests, and regression models controlling for baseline cigarettes/day.

RESULTS: Participants (n=340; 55.9% female) were, on average 53.4 (standard deviation: ±11.6) years old. At baseline, males smoked significantly more cigarettes/day than females (13.9±7.7 versus 11.9±6.3, respectively; p-value=0.031). Among those <45 years of age, males (n=30) had a greater reduction in cigarettes/day two weeks post cessation than females (n=52; 11.3±6.1 versus 7.9±5.3, respectively; p-value=0.008), but this difference became null after adjusting for baseline cigarettes/day (p-value=0.989). No other significant differences were identified.

CONCLUSIONS: After adjusting for baseline differences in smoking rate, no significant sex differences in smoking cessation outcomes were observed in this all-Black sample. Additional research is needed to replicate this observation.

IMPLICATIONS: Despite known racial disparities and sex-based differences in nicotine replacement therapy (NRT) efficacy, little is known about sex differences in cessation among Black people who smoke. While we did not observe any differences by sex in smoking cessation outcomes within this all-Black sample, our results suggest that sex differences in baseline level of cigarettes/day may play a critical role in cessation outcomes. Further research should replicate these observations and examine potential implications for cessation among Black people who smoke.

PMID:40105729 | DOI:10.1093/ntr/ntaf058

Ann Bot. 2025 Mar 19:mcaf046. doi: 10.1093/aob/mcaf046. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: Annuals produce little wood due to their short life cycle, while perennials can accumulate more, though not all do. Consequently, lifespan extension is a prerequisite for-but not synonymous with-secondary woodiness. Even if a shift to perenniality does not substantially increase wood production, it may still affect wood anatomy, as annuals prioritise rapid growth, whereas perennials invest in structural resilience. Heliophila, a genus of the Brassicaceae from the Cape Floristic Region, provides an excellent system to investigate drivers of secondary woodiness and the impact of lifespan shifts on wood traits due to its multiple independent lifespan transitions and occurrence of secondary woodiness.

METHODS: We reconstructed evolutionary transitions between annual and perennial lifespans and between herbaceous and secondarily woody habits. Using phylogenetically informed statistics, we analysed the relationship between climate, lifespan, and nine wood anatomical traits. Lifespan-specific evolutionary optima for these traits were estimated and compared. We also tested whether secondary woodiness in Heliophila is associated with specific climatic niches.

KEY RESULTS: Lifespan shifts in Heliophila are primarily driven by water availability and seasonality, with perennials evolving in wetter and less seasonal environments. Secondary woodiness may be more frequent in warmer niches, though this trend was not statistically supported, likely due to the limited number of secondarily woody species. Lifespan, not climate, better predicted wood traits: annuals had longer, thinner-walled cells, while perennials had shorter cells with thicker walls.

CONCLUSIONS: In Heliophila, a shift in climatic niche prompts a change in lifespan, followed by slower adaptations in wood anatomy. Possibly, this pattern arises because alterations in lifespan affect stem architecture, establishing a developmental framework that governs subsequent anatomical adjustments. Furthermore, although not statistically robust, increased wood production may be linked to warmer niches, potentially associated with a temperature-driven enhancement in lignin biosynthesis that reinforces stem structure.

PMID:40105725 | DOI:10.1093/aob/mcaf046

Epilepsia. 2025 Mar;66 Suppl 1:4-14. doi: 10.1111/epi.18307.

ABSTRACT

People with epilepsy who have uncontrolled seizures are at increased risk of all-cause mortality, injuries, comorbidities, mood and psychosocial disorders, and diminished quality of life. For those with focal epilepsy, focal to bilateral tonic-clonic seizures (FBTCS) pose the greatest risk for sudden unexpected death in epilepsy (SUDEP), a leading cause of premature mortality in people with epilepsy. Cenobamate is a third-generation antiseizure medication with demonstrated efficacy in controlling focal seizures, including FBTCS, in people with drug-resistant epilepsy. Treatment with cenobamate in clinical trials was associated with a reduction in all-cause mortality to a rate statistically indistinguishable from that seen in the general population, and SUDEP rates were lower than expected. As FBTCS are associated with the highest risk of death, prevention of this seizure type is especially important, and physicians should continue to try new therapies to prevent these seizures. A shared decision-making model should be used when interacting with patients and their care providers to achieve and maintain seizure control and maximize treatment outcomes.

PMID:40105710 | DOI:10.1111/epi.18307