Tag: nevin manimala

Soc Sci Med. 2024 Jun;351 Suppl 1:116396. doi: 10.1016/j.socscimed.2023.116396. Epub 2024 May 31.

ABSTRACT

RATIONALE: Immigrants represent a rapidly growing proportion of the population, yet the many ways in which structural inequities, including racism, xenophobia, and sexism, influence their health remains largely understudied. Perspectives from immigrant women can highlight intersectional dimensions of structural gendered racism and the ways in which racial and gender-based systems of structural oppression interact.

OBJECTIVE: This study aims to show the multilevel manifestations of structural gendered racism in the health experiences of immigrant women living in New York City.

METHOD: Semi-structured, in-depth interviews were conducted in 2020 and 2021 with 44 cisgender immigrant women from different national origins in New York City to explore how immigrant women experienced structural gendered racism and its pathways to their health. Interviews were thematically analyzed using a constant comparative approach.

RESULTS: Participants expressed intersectional dimensions of structural gendered racism and the anti-immigrant climate through restrictive immigration policy and issues related to citizenship status, disproportionate immigration enforcement and criminalization, economic exploitation, and gendered interpersonal racism experienced across a range of systems and contexts. Participants weighed their concerns for safety and facing racism as part of their life course and health decisions for themselves and their families.

CONCLUSIONS: The perspectives and experiences of immigrant women are key to identifying multilevel solutions for the burdens of structural gendered racism, particularly among individuals and communities of non-U.S. national origin. Understanding how racism, sexism, xenophobia, and intersecting systems of oppression impact immigrant women is critical for advancing health equity.

PMID:38825373 | DOI:10.1016/j.socscimed.2023.116396

J Rheumatol. 2024 Jun 1:jrheum.2023-1073. doi: 10.3899/jrheum.2023-1073. Online ahead of print.

ABSTRACT

OBJECTIVE: No prior studies in rheumatology have evaluated the quality or timeliness of patient reported outcome (PRO) measure reporting.

METHODS: Clinical trials that informed new Food and Drug Administration (FDA) approvals for the first rheumatological indication between 1995-2021 were identified. Whether collected PROs were published, met minimal clinically important (MCID) difference or statistical significance (p < 0.05) thresholds, or were consistent with CONSORT-PRO reporting standards was recorded. Hazard ratios and the Kaplan-Meier estimate were used to assess the time from FDA approval to PRO publication.

RESULTS: Thirty one FDA approvals corresponded with 110 pivotal trials and 262 reported patient reported outcome measures (PROs). One of the included studies (1.1%) met all five recommended items, 10/90 (11.1%) met 4 items, 17/90 (18.9%) met 3 items, 21/90 (23.3%) met 2 items, 26/90 (28.9%) met 1 item, and 15/90 (16.7%) met none of the reporting standards. Most PROs met MCID thresholds (149/262, 56.9%) and were statistically significant (223/262, 85.1%). Of our subset analysis, one third of PROs were not published upfront (70/212, 33.0%) and one of nine (22/212, 10.4%) remained unpublished four or more years after initial trial reporting. Publication rates were highest for HAQ-DI (97.4%) and lowest for SF-36 (81.8%). Less than half of these published PROs met MCID and statistical significance thresholds (94/212, 44.3%).

CONCLUSION: One in nine PROs remained unpublished for more than 4 years after initial trial reporting, and compliance with CONSORT PRO reporting guideline was poor. Efforts should be made to ensure PROs are adequately reported and expeditiously published.

PMID:38825357 | DOI:10.3899/jrheum.2023-1073

J Rheumatol. 2024 Jun 1:jrheum.2023-1246. doi: 10.3899/jrheum.2023-1246. Online ahead of print.

ABSTRACT

OBJECTIVE: There are limited data on the reproductive health of women with vasculitis. This study utilized a prospective, international vasculitis pregnancy registry to survey women during and after pregnancy.

METHODS: The Vasculitis Pregnancy Registry (VPREG) is imbedded within the Vasculitis Patient-Powered Research Network (VPPRN), an international online research infrastructure. Any pregnant woman with a diagnosis of vasculitis can self-enroll. After enrollment, women are invited to complete online surveys at study entry, once per trimester, and postpartum. Descriptive statistics are reported here.

RESULTS: Between 2015-2022, 147 women with 149 pregnancies enrolled in VPREG from 16 countries. Data on 78 pregnancies with known outcomes were included in this analysis. During pregnancy, women on average experienced low levels of pain related to vasculitis (scale 0-10, median 2 (IQR 1-5)) and preserved feelings of wellness (scale 0-10, median 3 (IQR 1-5)). Thirty-six percent of women reported their vasculitis was active during pregnancy. Of the 14 women requiring hospitalization during pregnancy outside of delivery, four cited active vasculitis as the indication. Most women (54/73, 74%) were prescribed medications for vasculitis during pregnancy. Seventy-six (97%) pregnancies resulted in live births with 64% delivering vaginally and 21% experiencing a preterm delivery.

CONCLUSION: These results demonstrate that most women with vasculitis can experience pregnancies that result in live births delivered at term. During pregnancy, a minority of women reported flares of vasculitis or the need for hospitalization due to vasculitis. These data are useful to rheumatologists and patients to inform and facilitate discussions about reproductive health and vasculitis.

PMID:38825354 | DOI:10.3899/jrheum.2023-1246

Acta Psychiatr Scand. 2024 Jun 2. doi: 10.1111/acps.13716. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear whether treatment early after onset in bipolar disorder may improve the long-term illness course. The early intervention in affective disorders (EIA) randomised controlled trial found that 2-years treatment in a specialised mood disorder clinic combining evidence-based pharmacological treatment with group psychoeducation improved clinical outcomes compared with standard treatment in patients with bipolar disorder discharged after their 1st, 2nd, or 3rd hospital admission. We aimed to assess the 16 years long-term outcomes after randomisation of the participants in the EIA trial.

METHODS: Data were obtained by linking nation-wide Danish population-based registers. All 158 participants of the EIA trial (Trial Registration Number NCT00253071) were followed from time of randomisation (2005-2009) to end of study (31 December 2021). The primary outcome was risk of psychiatric readmission. Secondary outcomes were total admissions and costs, medication use, intentional self-harm or suicide attempt or suicide, and socio-economic measures.

RESULTS: The absolute mean risk of psychiatric readmission was 49.3% in the intervention group and 59.8% in the control group, with no statistically significant difference between the groups (b = -0.10, 95% CI: -0.26 to 0.047, p = 0.18). Compared with the control group, patients in the intervention group had numerically fewer total admission days (mean (SD) 44 (77) versus 62 (109)), lower total cost of psychiatric hospital admissions and hospital-based outpatient visits (mean (SD) 22,001 (36793) euros versus 29,822 (52671) euros) and higher use of lithium and antipsychotics, but the differences were not statistically significant. Fewer patients in the intervention group had an event of intentional self-harm or suicide attempt or suicide during follow-up (OR 0.25, 95% CI: 0.15-0.40, p < 0.001) compared with the control group and more patients in the intervention group used antiepileptics (OR 2.21, 95% CI: 1.08-4.60, p = 0.031).

CONCLUSION: Analyses of very long-term outcomes of the EIA trial may potentially indicate a beneficial effect of the intervention at the long term but were likely underpowered to detect a more subtle effect and for most outcomes the differences between groups were not statistically significant.

PMID:38825333 | DOI:10.1111/acps.13716

J Oral Maxillofac Surg. 2024 May 17:S0278-2391(24)00294-5. doi: 10.1016/j.joms.2024.05.002. Online ahead of print.

ABSTRACT

BACKGROUND: The advantages of virtual surgical planning (VSP) for orthognathic surgery are clear. Previous studies have evaluated in-house VSP; however, few fully digital, in-house protocols for orthognathic surgery have been studied.

PURPOSE: The purpose of this study was to evaluate the difference between the virtual surgical plan and actual surgical outcome for orthognathic surgery using a fully digital, in-house VSP workflow.

STUDY DESIGN, SETTING, SAMPLE: This is a prospective cohort study from September 2020 to November 2022 of patients at the Victoria General Hospital in Halifax, NS, Canada who underwent bimaxillary orthognathic surgery. Patients were excluded if they had previously undergone orthognathic surgery or were diagnosed with a craniofacial syndrome.

MAIN OUTCOME VARIABLES: The primary outcome variables were the mean 3-dimensional (3D) (Euclidean) distance error, as well as mean error and mean absolute error in the transverse (x axis), vertical (y axis), and anterior-posterior (z axis) dimensions.

COVARIATES: Covariates included age, sex, and surgical sequence (mandible-first or maxilla-first).

ANALYSES: The primary outcome was tested using Z and t critical value confidence intervals. The P value was set at .05. The 3D distance error for mandible-first and maxilla-first groups was compared using a 2-sample t-test as well as analysis of variance.

RESULTS: The study sample included 52 subjects (24 males and 28 females) with a mean age of 27.7 (± 12.1) years. Forty three subjects underwent mandible-first surgery and 9 maxilla-first surgery. The mean absolute distance error was largest in the anterior-posterior dimension for all landmarks (except posterior nasal spine, left condyle, and gonion) and exceeded the threshold for clinical acceptability (2 mm) in 16 of 23 landmarks. Additionally, mean distance error in the anterior-posterior dimension was negative for all landmarks, indicating deficient movement in that direction. The effect of surgical sequence on 3D distance error was not statistically significant (P = .37).

CONCLUSION AND RELEVANCE: In general, the largest contributor to mean 3D distance error was deficient movement in the anterior-posterior direction. Otherwise, mean absolute distance error in the vertical and transverse dimensions was clinically acceptable (< 2 mm). These findings were felt to be valuable for treatment planning purposes when using a fully digital, in-house VSP workflow.

PMID:38825321 | DOI:10.1016/j.joms.2024.05.002

J Foot Ankle Surg. 2024 May 31:S1067-2516(24)00094-2. doi: 10.1053/j.jfas.2024.05.004. Online ahead of print.

ABSTRACT

Ankle fracture fixation using intramedullary fibular (IMF) nails has been shown to allow for earlier weightbearing, reduced wound complications, better union rates, and the absence of prominent hardware, compared to plates/screw (PS) constructs. The purpose of present retrospective cohort study was to compare outcomes of patients who underwent ankle fracture fixation using an IMF nail versus PS. Demographic, clinical, and radiographic data were recorded for patients who underwent ankle fracture fixation between May 2020 and May 2022, and who were at least 1 year postoperative. Toe-touch weightbearing was permitted immediately after surgery, protected weightbearing (PWB) at postoperative week 2, and weightbearing as tolerated in a brace at week 6. Radiographs were assessed preoperatively, and at 2, 6, 12, 24, and 48 weeks postoperative. Sixty-one ankle fractures (30 IMF, 31 PS) with a mean follow up of 14.7 and 18 (range, 12 to 23) months were included. Overall, the IMF nail cohort had less pain, faster time to union (11.4 vs 13.2 weeks), and less complications (23% vs 45%), reoperations (10% vs 16%), and surgical failures (9% vs 9.7%), compared to the PS cohort. The differences were not statistically significant. The PS cohort had a higher rate of symptomatic hardware irritation (p=<0.001). Tobacco use adversely effected direct osseous healing (p<0.001) and increased postoperative complications (p=0.050). The present study lends credence to the previously reported advantages of IMF nailing over PS fixation for ankle fractures. Ankle fracture fixation using a 4^th generation, IMF nail is a viable alternative to traditional PS fixation.

PMID:38825307 | DOI:10.1053/j.jfas.2024.05.004

J Pain Symptom Manage. 2024 May 31:S0885-3924(24)00797-8. doi: 10.1016/j.jpainsymman.2024.05.027. Online ahead of print.

ABSTRACT

Data sharing is increasingly an expectation in health research as part of a general move toward more open sciences. In the United States, in particular, the implementation of the 2023 National Institutes of Health Data Management and Sharing Policy has made it clear that qualitative studies are not exempt from this data sharing requirement. Recognizing this trend, the Palliative Care Research Cooperative Group (PCRC) realized the value of creating a de-identified qualitative data repository to complement its existing de-identified quantitative data repository. The PCRC Data Informatics and Statistics Core leadership partnered with the Qualitative Data Repository (QDR) to establish the first serious illness and palliative care qualitative data repository in the U.S. We describe the processes used to develop this repository, called the PCRC-QDR, as well as our outreach and education among the palliative care researcher community, which led to the first ten projects to share the data in the new repository. Specifically, we discuss how we co-designed the PCRC-QDR and created tailored guidelines for depositing and sharing qualitative data depending on the original research context, establishing uniform expectations for key components of relevant documentation, and the use of suitable access controls for sensitive data. We also describe how PCRC was able to leverage its existing community to recruit and guide early depositors and outline lessons learned in evaluating the experience. This work advances the establishment of best practices in qualitative data sharing.

PMID:38825257 | DOI:10.1016/j.jpainsymman.2024.05.027

Pract Radiat Oncol. 2024 May 31:S1879-8500(24)00135-8. doi: 10.1016/j.prro.2024.04.025. Online ahead of print.

ABSTRACT

PURPOSE: Cervical cancer patients undergoing chemoradiation have high symptom burden. We performed an analysis of prospectively collected patient-reported outcomes(PROs) to determine characteristics predictive of poor treatment experience.

METHODS: Between 2021-2023, we prospectively collected PROs from cervical cancer patients undergoing definitive chemoradiation. EORTC-QLQ-C30 and EORTC-QLQ-CX24 were completed at baseline(BL) and at the end of treatment(EOT). Poor treatment experience was defined as EOT poor health-related quality of life (HRQOL), low physical function, or significant overall symptom burden. Predictive factors analyzed included demographic, clinical, disease-specific factors, and baseline financial toxicity, depression, social function, and emotional function. ROC analysis provided appropriate predictive cut-off values. Univariable(UVA) and multivariable(MVA) linear regression analyses were performed.

RESULTS: Fourty-nine patients completed BL and EOT questionnaires. Median age was 43 (range, 18-85). Most patients (59%) had stage III disease. Baseline financial toxicity ≥66.7, depression ≥66.7, social function ≤50 and emotional function ≤58 on the EORTC linear transformed scale of 0-100 were significant predictors for poor treatment experience (p≤0.04) based on ROC analysis. On MVA poor BL social function was associated with reduced EOT HRQOL (β-9.3,_95%CI_-16.1_to_-2.6,_p<0.008), decreased physical function (β-24.4,_95%CI_-36.3_to_-12.6,_p<0.001), and high symptom burden_(β26.9,_95%CI_17.5_to_36.3,_p<0.001). Earlier disease stage predicted for decreased symptom burden_(β-6.7,_95%CI_-13.1_to_-0.3,_p=0.039). BL financial toxicity was a significant predictor on UVA (p=0.001-0.044) and showed a significant interaction term on MVA (p=0.024-0.041) for all three domains of poor treatment experience. Demographic and treatment-related factors were not predictive.

CONCLUSION: Cervical cancer patients with poor baseline social function or high financial toxicity were at-risk for increased symptom burden and poor HRQOL. Screening for these factors provides an opportunity for early intervention to improve treatment experience.

PMID:38825227 | DOI:10.1016/j.prro.2024.04.025

Sci Total Environ. 2024 May 31:173526. doi: 10.1016/j.scitotenv.2024.173526. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic rhinosinusitis (CRS) is a prevalent upper respiratory condition that manifests in two primary subtypes: CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). While previous studies indicate a correlation between air pollution and CRS, the role of genetic predisposition in this relationship remains largely unexplored. We hypothesized that higher air pollution exposure would lead to the development of CRS, and that genetic susceptibility might modify this association.

METHODS: This cohort study involving 367,298 adult participants from the UK Biobank, followed from March 2006 to October 2021. Air pollution metrics were estimated at residential locations using land-use regression models. Cox proportional hazard models were employed to explore the associations between air pollution exposure and CRS, CRSwNP, and CRSsNP. A polygenic risk score (PRS) was constructed to evaluate the joint effect of air pollution and genetic predisposition on the development of CRS.

RESULTS: We found that the risk of CRS increased under long-term exposure to PM_2.5 [the hazard ratios (HRs) with 95 % CIs: 1.59 (1.26-2.01)], PM₁₀ [1.64 (1.26-2.12)], NO₂ [1.11 (1.04-1.17)], and NO_x [1.18 (1.12-1.25)], respectively. These effects were more pronounced among participants with CRSwNP, although the differences were not statistically significant. Additionally, we found that the risks for CRS and CRSwNP increased in a graded manner among participants with higher PRS or higher exposure to PM_2.5, PM₁₀, or NO_x concentrations. However, no multiplicative or additive interactions were observed.

CONCLUSIONS: Long-term exposure to air pollution increases the risk of CRS, particularly CRSwNP underscoring the need to prioritize clean air initiatives and environmental regulations.

PMID:38825199 | DOI:10.1016/j.scitotenv.2024.173526

J Hosp Infect. 2024 May 31:S0195-6701(24)00193-2. doi: 10.1016/j.jhin.2024.04.028. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence were mixed regarding the effect of topical vancomycin (VCM) powder in reducing surgical site infection (SSI).

AIM: To clarify the effect of topical VCM powder for the prevention of in major orthopaedic surgeries.

METHODS: The MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov databases were searched from their inception to 25 September 2023. We included randomised controlled trials comparing topical VCM powder and controls for the prevention of SSI in major orthopaedic surgeries. Two reviewers independently screened the title and abstract and extracted relevant data, followed by the assessment of the risk of bias and the certainty of the evidence. Main outcome measure were Overall SSI, reoperation, and adverse events. Summary results were obtained using random-effects meta-analysis. We performed trial sequential analysis (TSA).

FINDINGS: Eight randomised controlled trials provided data on 4,307 participants. VCM powder showed no difference in reducing overall SSI. The cumulative number of patients did not exceed the required information size of 19,233 in our TSA, and the Z-curves did not cross the trial sequential monitoring or futility boundary, suggesting an inconclusive result of the meta-analysis. No difference was found for reoperation. Among SSI, VCM powder showed statistically significant difference in reducing gram-positive cocci SSI. However, the certainty of this evidence was very low.

CONCLUSIONS: This systematic review and meta-analysis suggests inconclusive results regarding the effect of VCM powder in reducing SSI in major orthopaedic surgeries. Further trials using rigorous methodologies are required to elucidate the effect of this intervention.

PMID:38825190 | DOI:10.1016/j.jhin.2024.04.028