Tag: nevin manimala

Eat Weight Disord. 2025 Feb 3;30(1):12. doi: 10.1007/s40519-025-01718-3.

ABSTRACT

PURPOSE: Intuitive exercise may foster healthier engagement in physical activity, leading to enhanced well-being and more intuitive eating habits. The Intuitive Exercise Scale (IEXS) was originally developed to assess this construct in English speakers. The IEXS is composed of four scales addressing distinct facets of intuitive exercise: emotional exercise, body trust, exercise rigidity, mindful exercise. The present study aimed to validate an Italian translation of the IEXS, exploring its factorial structure, invariance, internal consistency, and convergent validity.

METHODS: A sample of 1140 women and men (age: M = 45.25, SD = 11.64, range 22-76 years) was recruited from the Italian general population; 61.8% were physically active. Inclusion criteria were being an Italian native speaker and being at least 18 years. The sample was randomly split in two equal halves for the Exploratory Factor Analysis (n = 570; women: 50%; physically active: 61.8%) and the Confirmatory Factor Analysis (n = 570; women: 50%; physically active: 61.8%). Multi-group confirmatory factor analyses were performed to assess invariance among women and men and physically and non-physically active individuals. McDonald’s omega was used to assess internal consistency. Pearson’s correlations were utilized to assess convergent validity.

RESULTS: The Italian IEXS replicated a four-factor structure and showed good invariance among women and men. Invariance among physically and non-physically active individuals was only partially supported. Excellent internal consistency and adequate convergent validity were achieved.

CONCLUSIONS: The IEXS demonstrated to be a valid measure to examine intuitive exercise in the Italian population, replicating and expanding the findings of the English version. Level of evidence Level V, Cross-sectional, Psychometric study.

PMID:39899175 | DOI:10.1007/s40519-025-01718-3

J Am Heart Assoc. 2025 Feb 3:e029950. doi: 10.1161/JAHA.123.029950. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear.

METHODS AND RESULTS: This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFR_CT by sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; P=0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; P=0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; P=0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; P=0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; P=0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; P=0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (p=0.13).

CONCLUSIONS: There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.

PMID:39895531 | DOI:10.1161/JAHA.123.029950

J Am Heart Assoc. 2025 Feb 3:e037567. doi: 10.1161/JAHA.124.037567. Online ahead of print.

ABSTRACT

BACKGROUND: Using machine learning for the phenotyping of patients with heart failure with preserved ejection fraction (HFpEF) has emerged as a novel approach to understanding the pathophysiology and stratifying the patients. Our objective is to perform phenotyping of patients with HFpEF in stable phase and to investigate the phenotypic trajectory from acute worsening phase to stable phase.

METHODS: The present study is a post hoc analysis of the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study. We applied the latent class analysis to the discharge data of patients hospitalized for acute decompensated heart failure.

RESULTS: We finally included patient data of 1100 cases and 63 features in the latent class analysis. All patients were subclassified into 5 phenogroups as follows: Phenotype 1, characterized by better renal function and lower NT-proBNP (N-terminal pro-B-type natriuretic peptide) level [N=325 (29.5%)]; Phenotype 2, higher blood pressure, sinus rhythm, and poor renal function. [N=242 (22.0%)]; Phenotype 3, higher prevalence of atrial fibrillation, higher tricuspid pressure gradient, and lower tricuspid annular plane systolic excursion [N=214 (19.5%)]; Phenotype 4, higher C-reactive protein level and higher tricuspid pressure gradient [N=245 (22.3%)]; and Phenotype 5, poor nutritional status, poor renal function, and higher NT-proBNP level [N=74 (6.7%)]. A particular phenotype observed at the time of discharge was correlated with a distinct phenotype of acute worsening.

CONCLUSIONS: We identified 5 distinct stable phase phenotypes of the patients with HFpEF from the data at discharge. A specific phenotype at discharge was associated with a particular phenotype of acute worsening. This grouping can be a basis for future precision medicine of patients with HFpEF.

REGISTRATION: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000021831.

PMID:39895530 | DOI:10.1161/JAHA.124.037567

J Am Heart Assoc. 2025 Feb 3:e038484. doi: 10.1161/JAHA.124.038484. Online ahead of print.

ABSTRACT

BACKGROUND: Coronary microvascular dysfunction (CMD), which mimics symptoms of obstructive coronary artery disease, has significant prognostic implications. While epicardial adipose tissue normally has a protective role, increased epicardial adipose tissue is associated with inflammation and may contribute to CMD. However, a direct correlation remains unclear. We aimed to investigate this association.

METHODS AND RESULTS: The CMDR (Coronary Microvascular Disease Registry) is a prospective, 2-center registry that is enrolling patients with angina and nonobstructive coronary artery disease who underwent invasive hemodynamic assessment of the coronary microvasculature. Patients with chest computed tomography within 1 year of CMD evaluation were included. We measured epicardial fat volume (EFV) and calculated the EFV index. Logistic regression analysis was used to investigate the association between EFV and EFV index to CMD. Our study included 130 CMDR patients with associated chest CT; 35 were diagnosed with CMD. The CMD-negative patients were younger than the CMD-positive patients (58.52±11.97 versus 63.37±9.56 years; P=0.033), with numerically fewer women (64.2% versus 74.3%; P=0.279). Univariate regression analysis demonstrated a statistically significant association between EFV index and CMD diagnosis (odds ratio, 1.037 [95% CI, 1.014-1.063]; P=0.003), while no significance was observed for EFV (odds ratio, 1.006 [95% CI, 0.995-1.017]; P=0.292).

CONCLUSIONS: Our results suggest a strong association between EFV index (a significant risk factor) and the presence of CMD. Future studies involving larger cohorts are needed to confirm the association of epicardial adipose tissue with CMD and investigate therapeutic targets to prevent CMD.

REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT05960474.

PMID:39895522 | DOI:10.1161/JAHA.124.038484

Clin Exp Optom. 2025 Feb 3:1-8. doi: 10.1080/08164622.2025.2454532. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Resilience is a key enabler for healthcare professionals including optometrists, to cope with adversities and practice self-care. Evaluating the levels of resilience and its associated factors in optometry students can lead to the development of appropriate intervention strategies for academic and professional success.

BACKGROUND: The moderately high prevalence of mental health issues and burnout among optometry students suggests a need to equip the next generation of optometrists with the necessary skills to enhance mental health. Resilience has been shown to mitigate burnout among healthcare professionals and offer personal and professional benefits. Additionally, resilience education during healthcare student training can enhance mental health and wellbeing, leading to better patient care. This study aims to evaluate resilience levels and its associated factors (self-efficacy, mindfulness, positive and negative affect, and coping strategies) in optometry students.

METHODS: Students enrolled in optometry schools across eight institutions in six countries were invited to participate in an online survey within the period of April 2023 – January 2024. The survey comprised of demographic data, existing and validated questionnaires on resilience, self-efficacy, mindfulness, positive and negative affect, and coping strategies. Descriptive statistics and linear regressions were used for analysis.

RESULTS: A total of 294 valid responses were collected. There were no significant differences in resilience scores between countries. Greater resilience (p < 0.05) was associated with older age, higher academic grades and having no financial assistance. Additional predictors of greater resilience included higher self-efficacy, mindfulness, positive affect and acceptance scores, and lower behavioural disengagement scores.

CONCLUSION: Identifying factors that affect resilience in optometry students provides information for targeted strategies that enhance resilience. More work is required to understand the generalisability of these results, impact of culture on resilience, and appropriate intervention methods.

PMID:39895514 | DOI:10.1080/08164622.2025.2454532

Surg Laparosc Endosc Percutan Tech. 2025 Jan 28. doi: 10.1097/SLE.0000000000001200. Online ahead of print.

ABSTRACT

OBJECTIVE: Endoscopic papillary balloon dilation (EPBD), small endoscopic sphincterotomy (EST), and small EST plus EPBD are commonly used as rescue techniques to remove bile duct stones. However, we often encountered challenging cases with non-dilated distal bile ducts, especially in those undergoing EPBD. We aimed to explore the reasons by assessing whether patients without the dilated bile duct had a higher risk of early complications and whether it was impacted by the rescue techniques.

METHODS: We performed a retrospective cohort study by frequency matching design in patients diagnosed with stones in non-dilated distal bile duct who received rescue techniques from July 2016 to June 2022. Besides, patients with stones and without dilatation of the distal bile duct (DDBD) were divided into 3 subgroups according to the rescue technique received. Outcomes were compared between the subgroups.

RESULTS: The non-DDBD group was more likely to develop post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and hyperamylasemia (HP) than the DDBD group (P < 0.05). Some cases had mild or moderate pancreatitis, but no one in either group developed severe pancreatitis. For subgroup analysis, each technique resulted in complete stone removal; the EPBD group had a higher HP rate than the other subgroups and reached statistical significance: the EPBD group versus the small EST group (P = 0.013) and the EPBD group versus the EPBD plus small EST group (P = 0.008). Although there was no statistical significance, PEP incidence in the EPBD group was 13.7% higher than in other subgroups (P > 0.05/3).

CONCLUSION: Non-DDBD patients have a higher risk for endoscopic retrograde cholangiopancreatography-related pancreatic inflammation. EPBD should be used cautiously due to the significant association with increased rates of PEP and HP. Conversely, small EST and combination therapy are suitable for non-dilated bile duct stones because of their high safety profile and efficacy.

PMID:39895510 | DOI:10.1097/SLE.0000000000001200

Age Ageing. 2025 Feb 2;54(2):afae282. doi: 10.1093/ageing/afae282.

ABSTRACT

BACKGROUND: Medication review is integral in the pharmacological management of older inpatients.

OBJECTIVE: To assess the association of in-hospital medication changes with 28-day postdischarge clinical outcomes.

METHODS: Retrospective cohort of 2000 inpatients aged ≥75 years. Medication changes included the number of increases (medications started or dose-increased) and decreases (medications stopped or dose-decreased) for (i) all medications, (ii) Drug Burden Index (DBI)-contributing medications and (iii) Beers Criteria 2015 medications (potentially inappropriate medications, PIMs). Changes also included differences in (i) the number of medications, (ii) the number of PIMs and (iii) DBI score, at discharge versus admission. Associations with clinical outcomes (28-day ED visit, readmission and mortality) were ascertained using logistic regression, adjusted for age, gender and principal diagnosis. For mortality, sensitivity analysis excluded end-of-life patients due to higher death risk. Patients were stratified into : (i) ≤4, (ii) 5-9 and (iii) ≥10 discharge medications.

RESULTS: The mean age was 86 years (SD = 5.8), with 59.1% female. Medication changes reduced ED visits and readmission risk for patients prescribed five to nine discharge medications, with no associations in patients prescribed ≤4 and ≥ 10 medications. In the five to nine medications group, decreasing PIMs reduced risks of ED visit (adjusted odds ratio, aOR 0.55, 95% CI 0.34-0.91, P = .02) and readmission (aOR 0.62, 95% CI 0.38-0.99, P = .04). Decreasing DBI-contributing medications reduced readmission risk (aOR 0.71, 95% CI 0.51-0.99, P = .04). Differences in PIMs reduced ED visit risk (aOR 0.65, 95% CI 0.43-0.99, P = .04). There were no associations with mortality in sensitivity analyses in all groups.

DISCUSSION: Medication changes were associated with reduced ED visits and readmission for patients prescribed five to nine discharge medications.

PMID:39895509 | DOI:10.1093/ageing/afae282

Circ Cardiovasc Qual Outcomes. 2025 Feb 3:e011414. doi: 10.1161/CIRCOUTCOMES.124.011414. Online ahead of print.

ABSTRACT

BACKGROUND: The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) trial compared an investigational precision diagnostic testing strategy (n=1057) with usual testing (n=1046) in patients with stable chest pain and suspected coronary artery disease. Quality of life (QOL) outcomes were a prespecified secondary end point.

METHODS: We assessed QOL by structured interviews in all trial participants at baseline and 45 days, 6 months, and 12 months postrandomization. QOL assessments included angina-related QOL (19-item Seattle Angina Questionnaire [SAQ-19]), generic health status (EQ-5D), and a 4-item care satisfaction survey (at 45 days only). The prespecified primary comparison was the 6-month SAQ Summary score outcomes (scale, 0 to 100; higher scores indicate greater health status). QOL data collection rates were high, with 99% complete baseline SAQ scores and 86.5% complete at the 6-month primary comparison follow-up. All comparisons were made as randomized.

RESULTS: At baseline, mean SAQ Summary scores were 70.9 in the Precision Strategy group (n=1050) and 70.4 in the Usual Testing group (n=1042). By 6 months, mean SAQ Summary scores had improved to 89.9 in the Precision Strategy group and 89.2 in the Usual Testing group, with a mean adjusted difference of 0.8 (95% CI, -0.3 to 2.0). The SAQ component scores showed similar improvement from baseline in both groups and no statistically significant or clinically meaningful differences between the 2 groups at any follow-up time point. By 6 months, 66% of patients in both groups were chest pain-free. EQ-5D visual analog scores also improved from baseline and showed no difference between groups during follow-up. Care satisfaction scores were high and similar at 45 days.

CONCLUSIONS: In stable patients with symptoms suggesting coronary artery disease, angina-related and overall QOL improved substantially over the initial 6 months independent of the testing strategy assigned.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03702244.

PMID:39895494 | DOI:10.1161/CIRCOUTCOMES.124.011414

Diabetes Obes Metab. 2025 Feb 3. doi: 10.1111/dom.16224. Online ahead of print.

ABSTRACT

AIMS: Fibroblast growth factor (FGF) 23 is a bone-derived phosphaturic hormone that participates in the regulation of mineral metabolism and the development of chronic kidney disease. This study aimed to investigate the association between FGF23 and diabetic kidney disease (DKD) in a community-based prospective cohort.

MATERIALS AND METHODS: Of 7230 individuals who completed a 4.6-year follow-up survey, 1614 individuals with diabetes at baseline were included in this study. Baseline serum FGF23 levels were measured by enzyme-linked immunosorbent assay. Multiple and ordinal logistic regression analyses were used to examine the predictive performance of baseline FGF23 for incident DKD.

RESULTS: Baseline serum FGF23 levels exhibited an earlier elevation in the course of DKD and a gradual increase with the progressive stages of DKD (p < 0.05), while no statistical changes were observed in serum calcium and phosphorus levels. Over a 4.6-year follow-up, 198 individuals with diabetes developed incident DKD. Baseline FGF23 was significantly associated with the incidence of DKD (odds ratio 1.290 [95% CI 1.063, 1.565]) after adjusting for conventional DKD risk factors, especially in individuals with lower body mass index (<24 kg/m²), worse glycaemic control (HbA1c ≥7%), and shorter duration of diabetes (<5 years). Moreover, FGF23 models exhibited great performances in DKD risk prediction and yielded increments compared to traditional DKD risk factors (p < 0.05).

CONCLUSIONS: Serum FGF23 level increased at early stages of DKD, and it was an independent predictor of incident DKD, suggesting its potential for early identification of individuals at risk.

PMID:39895483 | DOI:10.1111/dom.16224

Biochem Mol Biol Educ. 2025 Feb 3. doi: 10.1002/bmb.21886. Online ahead of print.

ABSTRACT

Traditional didactic teaching methods in medical education, while foundational, often lead to passive learning and insufficient engagement. “Pancreata-The Keto Struggle,” an educational tale-based game for diabetic ketoacidosis (DKA), was developed to address these challenges by promoting collaborative learning, enhancing student engagement, and improving knowledge retention through an interactive and narrative-driven approach. This study involved 150 first-year medical students divided into 25 small groups of 6 each. Participants were assessed before and after engaging with the game through a structured formative assessment, a validated questionnaire measuring engagement and learning effectiveness, and a confidence level questionnaire. In-depth small-group interviews were also conducted for qualitative feedback and thematic analysis was performed. Statistical analyses were performed using SPSS version 17. The introduction of “Pancreata-The Keto Struggle” resulted in significant improvements in students’ formative assessment scores, from a mean of 19.2 ± 1.9 before the game to 39.3 ± 2.2 out of 50 after the game (p < 0.0001). Notably, students demonstrated the highest confidence gains in managing DKA and interpreting laboratory results. Qualitative analysis identified seven common themes reflecting the game’s impact on learning: collaboration, retention of concepts, internal drive, self and peer assessment, joyful learning, beyond books, and aesthetic content. Over 95% of students reported increased engagement and learning effectiveness due to the game’s intrinsic motivation, narrative, and group learning mechanics. “Pancreata-The Keto Struggle” effectively revitalizes collaborative learning in medical education by integrating game-based learning with traditional teaching methods. The game not only facilitates a deeper understanding of complex clinical conditions like DKA but also broadly improves students’ clinical management skills and confidence. These findings underscore the potential of educational tale based games to enrich medical education and advocate for their broader application across curricula.

PMID:39895468 | DOI:10.1002/bmb.21886