Tag: nevin manimala

JAMA Netw Open. 2025 Jan 2;8(1):e2453807. doi: 10.1001/jamanetworkopen.2024.53807.

ABSTRACT

IMPORTANCE: An unhealthy lifestyle is believed to increase the development and persistence of low back pain, but there is uncertainty about whether integrating support for lifestyle risks in low back pain management improves patients’ outcomes.

OBJECTIVE: To assess the effectiveness of the Healthy Lifestyle Program (HeLP) compared with guideline-based care for low back pain disability.

DESIGN, SETTING, AND PARTICIPANTS: This superiority, assessor-blinded randomized clinical trial was conducted in Australia from September 8, 2017, to December 30, 2020, among 346 participants who had activity-limiting chronic low back pain and at least 1 lifestyle risk (overweight, poor diet, physical inactivity, and/or smoking), referred from hospital, general practice, and community settings. Statistical analysis was performed from January to December 2021.

INTERVENTIONS: Participants were block randomized to the HeLP intervention (n = 174; 2 postrandomization exclusions) or guideline-based physiotherapy care (n = 172), stratified by body mass index, using a concealed function in REDCap. HeLP integrated healthy lifestyle support with guideline-based care using physiotherapy and dietetic consultations, educational resources, and telephone-based health coaching over 6 months.

MAIN OUTCOMES AND MEASURES: The primary outcome was low back pain disability (Roland Morris Disability Questionnaire [RMDQ] score; 0-24 scale, where higher scores indicate greater disability) at 26 weeks. Secondary outcomes were weight, pain intensity, quality of life, and smoking. Analyses were performed by intention to treat. We estimated the complier average causal effect (CACE) as sensitivity analyses.

RESULTS: The sample of 346 individuals (mean [SD] age, 50.2 [14.4] years; 190 female participants [55%]) had a baseline mean (SD) RMDQ score of 14.7 (5.4) in the intervention group and 14.0 (5.5) in the control group. At 26 weeks, the between-group difference in disability was -1.3 points (95% CI, -2.5 to -0.2 points; P = .03) favoring HeLP. CACE analysis revealed clinically meaningful benefits in disability among compliers, favoring HeLP (-5.4 points; 95% CI, -9.7 to -1.2 points; P = .01). HeLP participants lost more weight (-1.6 kg; 95% CI, -3.2 to -0.0 kg; P = .049) and had greater improvement in quality of life (physical functioning score; 1.8, 95% CI, 0.1-3.4; P = .04) than control participants.

CONCLUSIONS AND RELEVANCE: Combining healthy lifestyle management with guideline-based care for chronic low back pain led to small improvements in disability, weight, and quality of life compared with guideline-based care alone, without additional harm. Targeting lifestyle risks in the management of chronic low back pain may be considered safe and may offer small additional health benefits beyond current guideline-based care.

TRIAL REGISTRATION: http://anzctr.org.au Identifier: ACTRN12617001288314.

PMID:39792385 | DOI:10.1001/jamanetworkopen.2024.53807

JAMA Netw Open. 2025 Jan 2;8(1):e2454319. doi: 10.1001/jamanetworkopen.2024.54319.

ABSTRACT

IMPORTANCE: Understanding environmental risk factors for gestational diabetes (GD) is crucial for developing preventive strategies and improving pregnancy outcomes.

OBJECTIVE: To examine the association of county-level radon exposure with GD risk in pregnant individuals.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, population-based cohort study used data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort, which recruited nulliparous pregnant participants from 8 US clinical centers between October 2010 and September 2013. Participants who had pregestational diabetes or were missing data on GD or county-level radon measurements were excluded from the current study. Data were analyzed from September 2023 to January 2024.

EXPOSURES: County-level radon data were created by the Lawrence Berkeley National Laboratory based on the Environmental Protection Agency’s short- and long-term indoor home radon assessments. Radon exposure was categorized into 3 groups: less than 1, 1 to less than 2, and 2 or more picocuries (pCi)/L (to convert to becquerels per cubic meter, multiply by 37). Because radon, smoking, and fine particulate matter air pollutants (PM2.5) may share similar biological pathways, participants were categorized by joint classifications of radon level (<2 and ≥2 pCi/L) with smoking status (never smokers and ever smokers) and radon level with PM2.5 level (above or below the median).

MAIN OUTCOMES AND MEASURES: The main outcome was GD, identified based on glucose tolerance testing and information from medical record abstraction. Multiple logistic regression models were used to assess the association between radon exposure and GD.

RESULTS: Among the 9107 participants, mean (SD) age was 27.0 (5.6) years; 3782 of 9101 (41.6%) had ever used tobacco. The mean (SD) county-level radon concentration was 1.6 (0.9) pCi/L, and 382 participants (4.2%) had GD recorded. After adjusting for potential confounders, individuals living in counties with the highest radon level (≥2 pCi/L) had higher odds of developing GD compared with those living in counties with the lowest radon level (<1 pCi/L) (odds ratio [OR], 1.37; 95% CI, 1.02-1.84); after additional adjustment for PM2.5, the OR was 1.36 (95% CI, 1.00-1.86). Elevated odds of GD were also observed in ever smokers living in counties with a higher (≥2 pCi/L) radon level (OR, 2.09; 95% CI, 1.41-3.11) and participants living in counties with higher radon and PM2.5 levels (OR, 1.93; 95% CI, 1.31-2.83), though no statistically significant interactions were observed.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that higher radon exposure is associated with greater odds of GD in nulliparous pregnant individuals. Further studies are needed to confirm the results and elucidate the underlying mechanisms, especially with individual-level residential radon exposure assessment.

PMID:39792382 | DOI:10.1001/jamanetworkopen.2024.54319

JAMA Netw Open. 2025 Jan 2;8(1):e2454330. doi: 10.1001/jamanetworkopen.2024.54330.

ABSTRACT

IMPORTANCE: Preventive efforts in pregnancy-related alloimmunization have considerably decreased the prevalence of hemolytic disease of the fetus and newborn (HDFN). International studies are therefore essential to obtain a deeper understanding of the postnatal management and outcomes of HDFN. Taken together with numerous treatment options, large practice variations among centers may exist.

OBJECTIVES: To assess variations in postnatal management and outcomes of HDFN among international centers and to identify opportunities to improve care.

DESIGN, SETTING, AND PARTICIPANTS: In this international, retrospective, cohort study, 31 expert centers from 22 countries retrieved data on neonates with HDFN managed between January 1, 2006, and July 1, 2021. Statistical analysis was performed from July 19, 2023, to October 28, 2024.

MAIN OUTCOMES AND MEASURES: Main outcomes included the frequency of exchange transfusions, administration of intravenous immunoglobulin, administration of erythropoiesis-stimulating agents, and red blood cell transfusions, as well as the association of gestational age at birth with exchange transfusion frequency and risk factors for adverse neonatal outcomes.

RESULTS: The study included 1855 neonates (median gestational age at birth, 36.4 weeks [IQR, 35.0-37.3 weeks]; 1034 boys [55.7%]), of whom 1017 (54.8%) received any form of antenatal treatment. Most neonates (1447 [78.0%]) had anti-D antibodies. Exchange transfusions were performed in 436 neonates (23.5%), with proportions in exchange transfusion frequency varying from 0% to 78% among centers. Intravenous immunoglobulin was administered to 429 of 1743 neonates (24.6%), with proportions varying from 0% to 100% among centers. A higher gestational age at birth was associated with a reduction in exchange transfusion frequency in neonates with intrauterine transfusion, decreasing from approximately 38.2% (13 of 34) at 34 weeks to 16.8% (18 of 107) after 37 weeks and 0 days. A weekly increase in gestational age at birth was associated with a 43.3% decrease (95% CI, 36.1%-49.7%) in the likelihood of adverse neonatal outcomes, and neonates who received an exchange transfusion were 1.55 (95% CI, 1.10-2.18) times more likely to experience unfavorable outcomes.

CONCLUSIONS AND RELEVANCE: In this cohort study of neonates with HDFN managed at 31 centers in 22 countries, significant practice variations in the postnatal management of HDFN were identified, highlighting the lack of, and need for, consensus. The study suggests that there is a potential beneficial clinical association of waiting for delivery until after 37 weeks and 0 days with frequency of exchange transfusions among neonates with HDFN. The framework to implement international guidelines is provided.

PMID:39792381 | DOI:10.1001/jamanetworkopen.2024.54330

Am J Phys Med Rehabil. 2025 Jan 6. doi: 10.1097/PHM.0000000000002706. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to analyze the effect of a novel supervised exercise therapy (SET) program based on intermittent treadmill walking and circuit-based moderate-intensity functional training (MIFT) on walking performance and HRQoL in PAD patients.

DESIGN: All participants underwent a 12-week SET that involved 15 to 30 minutes of treadmill walking followed by a 15-minute moderate-intensity functional training (MIFT) continued by 12-week of follow-up. Maximum walking distance (MWD), pain-free walking distance (PFWD), gait speed and estimated peak oxygen uptake (peak VO2) were calculated through the 6-minute walk test (6-MWT) and HRQoL through the Short Form-36 (SF-36) and the Vascular Quality of Life Questionnaire-6 (VascuQol-6).

RESULTS: There were statistically significant differences (p < 0.05) between baseline and post-intervention for walking performance outcomes [MWD (MD: 88.53 m), PFWD (MD: 62.89 m), gait speed (MD: 0.24 m·s-1) and peak VO2 (MD: 2.04 ml·kg-1·min-1)] and for HRQoL [physical functioning in SF-36 (MD: 6.93 points) and VascuQol-6 (MD: 1.46 points)]; while no differences were found between baseline and 12-week follow-up.

CONCLUSION: Results seem to show that 12-week of novel SET based on intermittent walking and MIFT induced significant clinical improvements in key functional variables of PAD while cessation of exercise leads to significant negative clinical changes in subsequent weeks of follow-up.

PMID:39792377 | DOI:10.1097/PHM.0000000000002706

Am J Clin Pathol. 2025 Jan 10:aqae178. doi: 10.1093/ajcp/aqae178. Online ahead of print.

ABSTRACT

OBJECTIVES: Social media platforms like Facebook, X (formally Twitter), and Instagram bridge pathology programs with other health professionals, prospective students, and the public, but the extent of social media usage by residency programs remains unexplored. This study investigates the current landscape of social media utilization by pathology programs.

METHODS: Using the National Resident Matching Program (NRMP) Match Data from 2022, 139 anatomic and clinical pathology residency programs were analyzed and categorized into 3 prestige tiers based on Doximity ratings. There were 32,067 posts examined between January 2018 and August 2022. Statistical analyses, including analysis of variance and Tukey honestly significant difference post hoc analysis, were performed to evaluate likes/views about post type.

RESULTS: X emerged as the most used platform (68%), focusing on pathology education (27.02%). Instagram centered on resident life (25.84%), while Facebook showcased person-specific posts (35.61%). Notably, there was a correlation between program prestige and the number of posts on X and Instagram, with the most prestigious programs posting more frequently than those considered more intermediate or low in prestige rank.

CONCLUSIONS: Social media is vital in connecting pathology programs with various stakeholders. Despite seasonal fluctuations, the overall utilization of social media continues to rise, underscoring its value as a long-term resource for pathology education and communication.

PMID:39792363 | DOI:10.1093/ajcp/aqae178

Esophagus. 2025 Jan 10. doi: 10.1007/s10388-025-01106-x. Online ahead of print.

ABSTRACT

BACKGROUND: Neoadjuvant chemotherapy is standard for advanced esophageal squamous cell carcinoma, though often ineffective. Therefore, predicting the response to chemotherapy before treatment is desirable. However, there is currently no established method for predicting response to neoadjuvant chemotherapy. This study aims to build a deep-learning model to predict the response of esophageal squamous cell carcinoma to preoperative chemotherapy by utilizing multimodal data integrating esophageal endoscopic images and clinical information.

METHODS: 170 patients with locally advanced esophageal squamous cell carcinoma were retrospectively studied, and endoscopic images and clinical information before neoadjuvant chemotherapy were collected. Endoscopic images alone and endoscopic images plus clinical information were each analyzed with a deep-learning model based on ResNet50. The clinical information alone was analyzed using logistic regression machine learning models, and the area under a receiver operating characteristic curve was calculated to compare the accuracy of each model. Gradient-weighted Class Activation Mapping was used on the endoscopic images to analyze the trend of the regions of interest in this model.

RESULTS: The area under the curve by clinical information alone, endoscopy alone, and both combined were 0.64, 0.55, and 0.77, respectively. The endoscopic image plus clinical information group was statistically more significant than the other models. This model focused more on the tumor when trained with clinical information.

CONCLUSIONS: The deep-learning model developed suggests that gastrointestinal endoscopic imaging, in combination with other clinical information, has the potential to predict the efficacy of neoadjuvant chemotherapy in locally advanced esophageal squamous cell carcinoma before treatment.

PMID:39792350 | DOI:10.1007/s10388-025-01106-x

Sports Med. 2025 Jan 10. doi: 10.1007/s40279-024-02152-8. Online ahead of print.

ABSTRACT

BACKGROUND: Aging is associated with sustained low-grade inflammation, which has been linked to age-related diseases and mortality. Long-term exercise programs have been shown to be effective to for attenuating this process; however, subsequent detraining might negate some of these benefits. Master athletes, as a model of lifelong consistent exercise practice, have been suggested to present similar inflammatory profiles to untrained young adults. Nonetheless, it is unclear whether maintaining training habits throughout life can completely counteract low-grade inflammation associated with aging.

OBJECTIVES: We aimed to systematically evaluate comparisons of baseline inflammatory profiles in Master athletes, untrained middle-aged and older adults, and untrained young individuals to elucidate whether lifelong exercise can counteract low-grade inflammation associated with aging.

METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and a protocol was prospectively registered in PROSPERO (CRD42024521339). Studies reporting baseline systemic levels of proinflammatory and anti-inflammatory markers in Master athletes and untrained controls were eligible for inclusion. A total of six databases (PubMed [MEDLINE], Embase, Cochrane Central Register of Controlled Trials [CENTRAL], Scopus, SPORTDiscus, and Web of Science [WoS]) were searched in September 2024, and studies were independently screened by two reviewers. Risk of bias was assessed using an adapted version of the Joanna Briggs Institute Critical Appraisal tool for cross-sectional trials, and random-effect meta-analyses of standardized mean differences (SMDs) of inflammatory markers were conducted to evaluate comparisons between Master athletes and age-matched untrained middle-aged and older adults as well as Master athletes and young untrained subjects. Subgroup analyses were performed based on exercise intensity and type, and participants’ sex.

RESULTS: A total of 17 studies (n = 649 participants) were included both in qualitative and quantitative synthesis. Lifelong exercise appears to attenuate increases in baseline C-reactive protein, and to elevate anti-inflammatory interleukin (IL)-10 levels compared with untrained middle-aged and older adults (C-reactive protein: SMD – 0.71, 95% confidence interval – 0.97, – 0.45, I² 0%, p = 0.78; IL-10: SMD 1.44, 95% confidence interval 0.55, 2.32, I² 87%, p < 0.00001). Statistical significance was maintained in C-reactive protein and IL-10 sub-analyses. No difference in tumor necrosis factor-α levels was observed between Master athletes and untrained middle-aged and older adults (SMD 0.40, 95% confidence interval – 0.15, 0.96, I² 72%, p = 0.0008). A trend towards decreased IL-6 levels in Master athletes was shown in pooled analyses comparing untrained middle-aged and older adults, and rendered statistically significant in sub-analyses. However, comparisons with young untrained adults indicated that Master athletes still present with elevated levels of tumor necrosis factor-α and IL-6, along with decreased IL-10.

CONCLUSIONS: Master athletes might exhibit a more anti-inflammatory profile denoted by decreased baseline circulating levels of C-reactive protein and, potentially, IL-6, along with increased IL-10 compared with healthy age-matched untrained peers. However, lifelong exercise might still be insufficient to completely counteract age-related changes in tumor necrosis factor-α, IL-6, and IL-10, as shown in comparisons with untrained young adults.

PMID:39792347 | DOI:10.1007/s40279-024-02152-8

Int J Legal Med. 2025 Jan 10. doi: 10.1007/s00414-024-03398-7. Online ahead of print.

ABSTRACT

The burnout phenomenon is a subject of considerable interest due to its impact on both employee well-being and scientific inquiry. Workplace factors, both intrinsic and extrinsic, play a pivotal role in its development, often leading to job dissatisfaction and heightened burnout risk. Chronic stress and burnout induce significant dysregulation in the autonomic nervous system and hormonal pathways, alongside structural brain changes. This paper presents a preliminary review of the literature on burnout syndrome among forensic science workers, focusing on the prevalence of this phenomenon and its triggers. This review aims to consolidate existing research on burnout among forensic medicine workers, highlight significant findings, and encourage further studies. Symptoms range from demoralization to somatic complaints. The Maslach Burnout Inventory (MBI) was the main tool in assessing burnout levels alongside measures of occupational stress, vicarious trauma and posttraumatic stress syndrome. Forensic medicine workers face unique stressors, with notable impacts on burnout levels. These workers experience challenges such as workplace conflicts and exposure to traumatic cases, leading to moderate or high burnout levels, particularly, emotional exhaustion, depersonalization or low personal accomplishment. Despite the prevalence of burnout, many forensic medicine workers lack access to support networks and perceive a disregard for their well-being from supervisors. There is a pressing need for further research to understand the biological mechanisms, susceptibility factors, and discover diagnostic markers of burnout syndrome, with the goal of its recognition as a psychiatric disorder in diagnostic manuals like the Diagnostic and Statistical Manual of Mental Disorders.

PMID:39792327 | DOI:10.1007/s00414-024-03398-7

Environ Monit Assess. 2025 Jan 10;197(2):155. doi: 10.1007/s10661-024-13431-2.

ABSTRACT

Recent advancements in satellite technology have greatly expanded data acquisition capabilities, making satellite imagery more accessible. Despite these strides, unlocking the full potential of satellite images necessitates efficient interpretation. Image classification, a widely adopted for extracting valuable information, has seen a surge in the application of deep learning methodologies due to their effectiveness. However, the success of deep learning is contingent upon the quality of the training data. In our study, we compared the efficiency of pixel-based and object-based classifications in Sentinel-2 satellite imagery using the Deeplabv3 deep learning method. The image sharpness was enhanced through a high-pass filter, aiding in data visualization and preparation. Deeplabv3 underwent training, leading to the development of classifiers following the extraction of training samples from the enhanced image. The majority zonal statistic method was implemented to assign class values to objects in the workflow. The accuracy of pixel-based and object-based classification was 83.1% and 83.5%, respectively, with corresponding kappa values of 0.786 and 0.791. These accuracies highlighted the efficient performance of the object-based method when integrated with a deep learning classifier. These results can serve as a valuable reference for future studies, aiding in the improvement of accuracy while potentially saving time and effort. By evaluating this nuanced impact pixel and object-based classification as well as on class-specific accuracy, this research contributes to the ongoing refinement of satellite image interpretation techniques in environmental applications.

PMID:39792312 | DOI:10.1007/s10661-024-13431-2

Sleep. 2025 Jan 10:zsaf007. doi: 10.1093/sleep/zsaf007. Online ahead of print.

ABSTRACT

STUDY OBJECTIVES: Exploding head syndrome (EHS) is a parasomnia characterized by the perception of loud noises, or explosions inside the head during the sleep-to-wake transition. The prevalence of EHS remains unclear. This survey aimed to elucidate the prevalence of and factors associated with EHS in this cohort.

METHODS: As part of the Night in Japan Home Sleep Monitoring Study (NinjaSleep study), a cross-sectional survey was conducted among government employees in Koka City, Shiga Prefecture, Japan, in 2022. Participants were queried regarding their experiences with EHS as defined in the International Classification of Sleep Disorders, 3rd Edition, including sudden loud noises or sensations of explosions, subsequent abrupt awakenings and feelings of fright. Various standardized instruments were employed to evaluate depression, anxiety, insomnia, quality of life, and fatigue.

RESULTS: Of the 2081 employees invited to participate, 1878 completed the survey. After excluding respondents with epilepsy and incomplete responses, 1843 participants were deemed eligible for analysis. Among them, 46 (2.49%) reported experiencing sudden noises or sensations of explosions, with 23 (1.25%) meeting the diagnostic criteria for EHS. The EHS was significantly related to the scores on the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Athens Insomnia Scale, and Chalder Fatigue Scale, even after adjusting for age, sex, BMI and categorized mean sleep duration.

CONCLUSION: This study elucidates the prevalence of EHS among the Japanese population and underscores its potential association with insomnia symptoms and various psychological factors.

PMID:39792308 | DOI:10.1093/sleep/zsaf007