Tag: nevin manimala

J Evid Based Med. 2024 Mar 19. doi: 10.1111/jebm.12598. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar disc herniation (LDH), as one of the most common causes of lower back pain, imposes a heavy economic burden on patients and society. Conservative management is the first-line choice for the majority of LDH patients. Traditional Chinese medicine (TCM) is an important part of conservative treatment and has attracted more and more international attention.

STUDY DESIGN: Evidence-based guideline.

METHODS: We formed a guideline panel of multidisciplinary experts. The clinical questions were identified on the basis of a systematic literature search and a consensus meeting. We searched the literature for direct evidence on the management of LDH and assessed its certainty-generated recommendations using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.

RESULTS: The guideline panel made 20 recommendations, which covered the use of Shentong Zhuyu decoction, Shenzhuo decoction, Simiao San decoction, Duhuo Jisheng decoction, Yaobitong capsule, Yaotongning capsule, Osteoking, manual therapy, needle knife, manual acupuncture, electroacupuncture, Chinese exercise techniques (Tai Chi, Baduanjin, or Yijinjing), and integrative medicine, such as combined non-steroidal anti-inflammatory drugs, neural nutrition, and traction. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement.

CONCLUSION: This is the first LDH treatment guideline for TCM and integrative medicine with a systematic search, synthesis of evidence, and using the GRADE method to rate the quality of evidence. We hope these recommendations can help support healthcare workers caring for LDH patients.

PMID:38502879 | DOI:10.1111/jebm.12598

J Evid Based Med. 2024 Mar 19. doi: 10.1111/jebm.12600. Online ahead of print.

ABSTRACT

OBJECTIVE: Time-varying treatments are common in observational studies. However, when assessing treatment effects, the methodological framework has not been systematically established for handling time-varying treatments. This study aimed to examine the current methods for dealing with time-varying treatments in observational studies and developed practical recommendations.

METHODS: We searched PubMed from 2000 to 2021 for methodological articles about time-varying treatments, and qualitatively summarized the current methods for handling time-varying treatments. Subsequently, we developed practical recommendations through interactive internal group discussions and consensus by a panel of external experts.

RESULTS: Of the 36 eligible reports (22 methodological reviews, 10 original studies, 2 tutorials and 2 commentaries), most examined statistical methods for time-varying treatments, and only a few discussed the overarching methodological process. Generally, there were three methodological components to handle time-varying treatments. These included the specification of treatment which may be categorized as three scenarios (i.e., time-independent treatment, static treatment regime, or dynamic treatment regime); definition of treatment status which could involve three approaches (i.e., intention-to-treat, per-protocol, or as-treated approach); and selection of analytic methods. Based on the review results, a methodological workflow and a set of practical recommendations were proposed through two consensus meetings.

CONCLUSIONS: There is no consensus process for assessing treatment effects in observational studies with time-varying treatments. Previous efforts were dedicated to developing statistical methods. Our study proposed a stepwise workflow with practical recommendations to assist the practice.

PMID:38502877 | DOI:10.1111/jebm.12600

Facial Plast Surg Aesthet Med. 2024 Mar 19. doi: 10.1089/fpsam.2023.0079. Online ahead of print.

ABSTRACT

Background: Noma is a gangrenous infection of the face that results in severe facial deformity, occurring primarily in malnourished and impoverished populations. Objective: To assess clinician- and patient-reported outcomes (PROs) before and after reconstructive surgery for patients with noma in northwest Nigeria. Methods: Objective outcomes were recorded using the noma-specific NOITULP (nose, outer cheek, inner cheek, trismus, upper/lower lip, particularities) classification system. PROs were recorded using a locally developed tool. Postsurgical changes were assessed by Wilcoxon signed-rank testing. Linear regression was used to look for associated risk factors. The inter-rater reliability (IRR) of the NOITULP score was assessed using the weighted kappa statistic. Results: Forty-nine patients (median age 25 years, 71% male) underwent local/regional flap reconstruction and/or trismus release. Twelve complications were reported. Univariate analysis showed a 3.20 change in PRO score (95% confidence interval 0.59 to 5.81, p = 0.018) per kilogram the patient underwent at time of surgery. The NOITULP score improved from a presurgery median of 3.5 to 2.3 (p < 0.0001), however, the IRR was poor (kappa = 0.0894, p < 0.0001). The PRO score also improved from a median of 7.0 to 12.0 (p < 0.0001). Conclusions: Facial reconstructive surgery improves the NOITULP score and PROs in patients with noma in northwest Nigeria. Clinical Trial Registration: OCA017-63.

PMID:38502845 | DOI:10.1089/fpsam.2023.0079

J Womens Health (Larchmt). 2024 Mar 19. doi: 10.1089/jwh.2023.0610. Online ahead of print.

ABSTRACT

Background: Tubal sterilization is more commonly utilized by racial/ethnic minority groups and has been implicated in underscreening for cervical cancer. The objective is to determine if prior tubal sterilization is a risk factor for cervical cancer underscreening. Methods: National Survey of Family Growth dataset from 2015 to 2019 used for analysis; data were weighted to represent the 72 million women in the U.S. population aged 22-49. Chi-square tests, Fisher exact tests, and logistic regression were used for analysis. The primary predictor variable was tubal sterilization which was categorized into no previous sterilization, sterilization completed <5 years ago, and sterilization completed ≥5 years ago. The outcome variable was underscreened versus not underscreened. Other predictor variables included age, household income as a percent of federal poverty level, previous live birth, primary care provider, and insurance status. Results: Prevalence of tubal sterilization completed 5 or more years ago was 12.5% and varied by most measured characteristics in univariate analyses. Approximately 8% of women were underscreened for cervical cancer. In multivariable analyses, women with a tubal sterilization 5 or more years ago had 2.64 times the odds (95% confidence interval = 1.75-4.00) of being underscreened for cervical cancer compared with women who did not have a tubal sterilization. Conclusions: Approximately 4.3 million women ages 22-49 in the United States are potentially underscreened for cervical cancer and women with previous tubal ligation ≥5 years ago are more likely to be underscreened. These results may inform the need for culturally sensitive public health messages informing people who have had these procedures about the need for continued screening.

PMID:38502830 | DOI:10.1089/jwh.2023.0610

Vector Borne Zoonotic Dis. 2024 Mar 19. doi: 10.1089/vbz.2023.0134. Online ahead of print.

ABSTRACT

Background: Ehrlichia canis has been the main hemopathogen affecting domestic dogs in Brazil. Even though tick-infested dogs may lead to household infestation and predispose human exposure and public health concern, no comprehensive study has surveyed humans, dogs, and environmental ticks altogether. Materials and Methods: Accordingly, the present study aimed to assess tick-infested households, identify tick species, perform serological (immunofluorescence assay) and molecular (PCR and q-PCR) detection of Ehrlichia in ticks, in the eighth biggest metropolitan area of Brazil. Results: Between 2007 and 2020, 233/5973 (3.9%) out of all complaints were from tick-infested households of 200 different addresses. Overall, 370/552 (67.0%) ticks were collected and identified as adult and 182/552 (33.0%) as immature forms of Rhipicephalus sanguineus s.l. complex; a single tick from one owner, a female tick of Amblyomma sculptum; and 395 ticks from dogs, 319/395 (80.8%) adult and 72/395 (18.2%) immature forms of Rhipicephalus spp., and 4/395 (1.01%) female Amblyomma aureolatum. Overall, 2/135 (1.5%) owners and 13/136 (9.6%) dogs were seropositive for E. canis. The DNA of Anaplasmataceae family was molecularly detected in 16/50 (32.0%) R. sanguineus s.l. As expected, the number of monthly tick infestation complaints were directly associated, and mean (p = 0.01), maximum (p = 0.011), and minimum (p = 0.008) temperature were statistically significant and had a low positive correlation (0.24, 0.23, and 0.24, respectively). In addition, complaints were highly associated to all socioeconomic variables (p < 0.001), with the exception of the presence of vacant lots. Conclusions: Despite low samplings and human negative results, areas with low-income with adequate temperature and urban agglomerations have been shown to be associated risks for tick infestations, predisposing tick-borne diseases. In conclusion, monitoring should always be conducted in such areas, including One Health approach with serosurvey of owners and dogs, along with identification and molecular screening of ticks.

PMID:38502822 | DOI:10.1089/vbz.2023.0134

J Prosthodont. 2024 Mar 19. doi: 10.1111/jopr.13844. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to assess Candida albicans attachment on conventionally fabricated (polymethylmethacrylate, PMMA), CAD-CAM milled, and 3D-printed acrylic resin bases pre- and post-simulated thermal aging, along with examining material surface changes after aging.

MATERIALS AND METHODS: Forty-six samples (10 mm × 10 mm × 2 mm) for each of four material groups (conventional heat-polymerized PMMA, CAD-CAM milled acrylic resin base, CAD-CAM 3D-printed methacrylate resin base, CAD-CAM 3D-printed urethane methacrylate resin base) were subjected to 0, 1, or 2 years of simulated thermal aging. Microscopic images were taken before and after aging, and C. albicans attachment was quantified using cell proliferation assay (XTT). Statistical analysis employed analysis of variance (α = 0.05).

RESULTS: Two-way factorial analysis showed no significant differences based on acrylic resin type or thermal aging (p = 0.344 and p = 0.091 respectively). However, C. albicans attachment significantly differed between 0- and 2-year thermally aged groups (p = 0.004), mainly due to elevated initial attachments on CAD-CAM milled acrylic resin base and CAD-CAM 3D-printed urethane methacrylate resin base.

CONCLUSIONS: Regardless of the fabrication technique and material combination, no significant differences were found in C. albicans adhesion pre- or post- thermal aging. Milled and 3D-printed bases compared favorably with heat- polymerized PMMA in their affinity for C. albicans attachment and surface characteristics after aging. These findings indicate that the risk of patients developing denture stomatitis might not be linked to the type of acrylic resin or fabrication method used.

PMID:38502779 | DOI:10.1111/jopr.13844

Am J Speech Lang Pathol. 2024 Mar 19:1-12. doi: 10.1044/2024_AJSLP-23-00332. Online ahead of print.

ABSTRACT

PURPOSE: Socioeconomically disadvantaged areas are more resource poor, impacting adherence to swallowing care recommendations. Neighborhood-level disadvantage metrics, such as the Area Deprivation Index (ADI), allow for examination of social determinants of health (SDOH) in a precise region. We examined ADI in a cohort of persons living with dementia (PLWD) to determine representation of those residing in areas of socioeconomic disadvantage (high ADI), distribution of swallowing care provided, and frequency of SDOH-related counseling or resource linking prior to discharge.

METHOD: A retrospective chart abstraction was performed for all inpatients with a diagnosis of dementia (N = 204) seen by the Swallow Service at a large academic hospital in 2014. State ADI Deciles 1 (least) to 10 (most socioeconomic disadvantage) and decile groups (1-3, 4-7, and 8-10) were compared with the surrounding county. Frequency of videofluoroscopic swallowing evaluations (VFSEs) based on ADI deciles was recorded. To determine whether SDOH-related counseling or resource linking occurred for those in high ADI (8-10) neighborhoods, speech-language pathology notes, and discharge summaries were reviewed. Descriptive statistics, independent samples t tests, and one-way analysis of variance were calculated.

RESULTS: ADI was significantly higher in this cohort (M = 3.84, SD = 2.58) than in the surrounding county (M = 2.79, SD = 1.88, p = .000). There was no significant difference in utilization of swallowing services across decile groups (p = .88). Although the majority (85%) in high ADI areas was recommended diet modifications or alternative nutrition likely requiring extra resources, there was no documentation indicating that additional SDOH resource linking or counseling was provided.

CONCLUSIONS: These findings raise important questions about the role and responsibility of speech-language pathologists in tailoring swallowing services to challenges posed by the lived environment, particularly in socioeconomically disadvantaged areas. This underscores the need for further research to understand and address gaps in postdischarge support for PLWD in high-ADI regions and advocate for more equitable provision of swallowing care.

PMID:38502719 | DOI:10.1044/2024_AJSLP-23-00332

Scand J Pain. 2024 Mar 19;24(1). doi: 10.1515/sjpain-2023-0113. eCollection 2024 Jan 1.

ABSTRACT

OBJECTIVES: Perceived pain is a multi-factorial subjective variable, commonly measured by numeric rating scales, verbal descriptive scales (VDS), or by a position on an analogue line (VAS). A major question is whether an individual’s VAS and VDS pain assessments, on the same occasion, could be comparable. The aim was to compare continuous and discretized VAS pain data with verbal descriptive pain datasets from the Oswestry Disability Index (ODI) and the European Quality of Life Scale (EQ-5D) in paired pain datasets.

METHODS: The measurement level of data from any type of scale assessments is ordinal, having rank-invariant properties only. Non-parametric statistical methods were used. Two ways of discretizing the VAS-line to VAS-intervals to fit the number of the comparing VDS-categories were used: the commonly used (equidistant VAS,VDS)-pairs and the (unbiased VAS,VDS)-pairs of pain data. The comparability of the (VAS,VDS)-pairs of data of perceived pain was studied by the bivariate ranking approach. Hence, each pair will be regarded as ordered, disordered, or tied with respect to the other pairs of data. The percentage agreement, PA, the measures of disorder, D, and of order consistency, MA, were calculated. Total interchangeability requires PA = 1 and MA = 1.

RESULTS: The wide range of overlapping of (VAS,VDS)-pairs indicated that the continuous VAS data were not comparable to any of the VDS pain datasets. The percentage of agreement, PA; in the (equidistant VAS,ODI) and (equidistant VAS, EQ-5D) pairs were 38 and 49%, and the order consistency, MA, was 0.70 and 0.80, respectively. Corresponding results for the (unbiased VAS,VDS)-pairs of pain data were PA: 54 and 100%, and MA: 0.77 and 1.0.

CONCLUSION: Our results confirmed that perceived pain is the individual’s subjective experience, and possible scale-interchangeability is only study-specific. The pain experience is not possible to be measured univocally, but is possible for the individual to rate on a scale.

PMID:38502712 | DOI:10.1515/sjpain-2023-0113

PLoS One. 2024 Mar 19;19(3):e0298526. doi: 10.1371/journal.pone.0298526. eCollection 2024.

ABSTRACT

BACKGROUND: Orthodontic systematic reviews (SRs) use different methods to pool the individual studies in a meta-analysis when indicated. However, the number of studies included in orthodontic meta-analyses is relatively small. This study aimed to evaluate the direction of estimate changes of orthodontic meta-analyses (MAs) using different between-study variance methods considering the level of heterogeneity when few trials were pooled.

METHODS: Search and study selection: Systematic reviews (SRs) published over the last three years, from the 1st of January 2020 to the 31st of December 2022, in six main orthodontic journals with at least one MA pooling five or lesser primary studies were identified. Data collection and analysis: Data were extracted from each eligible MA, which was replicated in a random effect model using DerSimonian and Laird (DL), Paule-Mandel (PM), Restricted maximum-likelihood (REML), Hartung Knapp and Sidik Jonkman (HKSJ) methods. The results were reported using median and interquartile range (IQR) for continuous data and frequencies for categorical data and analyzed using non-parametric tests. The Boruta algorithm was used to assess the significant predictors for the significant change in the confidence interval between the different methods compared to the DL method, which was only feasible using the HKSJ method.

RESULTS: 146 MAs were included, most applying the random effect model (n = 111; 76%) and pooling continuous data using mean difference (n = 121; 83%). The median number of studies was three (range 2, 4), and the overall statistical heterogeneity (I2 ranged from 0 to 99% with a median of 68%). Close to 60% of the significant findings became non-significant when HKSJ was applied compared to the DL method and when the heterogeneity was present I2>0%. On the other hand, 30.43% of the non-significant meta-analyses using the DL method became significant when HKSJ was used when the heterogeneity was absent I2 = 0%.

CONCLUSION: Orthodontic MAs with few studies can produce different results based on the between-study variance method and the statistical heterogeneity level. Compared to DL, HKSJ method is overconservative when I2 is greater than 0% and may result in false positive findings when the heterogeneity is absent.

PMID:38502662 | DOI:10.1371/journal.pone.0298526

PLoS One. 2024 Mar 19;19(3):e0300677. doi: 10.1371/journal.pone.0300677. eCollection 2024.

ABSTRACT

This study aims to integrate research in the field of aerobics and mental health through the visualization analysis method of the CiteSpace map, to clarify the impact of aerobics on mental health and stress levels. Firstly, based on the literature method, pieces of literature related to aerobics and mental health are searched and collected. Secondly, the visualization analysis method of the CiteSpace map is employed to summarize and analyze the contents of the literature, involving statistical analysis of the annual number of publications, analysis of author characteristics, and analysis of publishing institution characteristics. In addition, keyword co-occurrence analysis and keyword cluster analysis are also conducted in related research fields. Among them, the Log-Likelihood Ratio is used in keyword cluster analysis. Finally, the results are analyzed using the visualization analysis method of the CiteSpace map and the statistics-based comprehensive results. The results demonstrate that in the recent 20 years, the average annual number of articles in related fields exceeds 190. The high-yield authors are distributed in economically developed areas, and the cooperation among authors is scattered. In the keyword clustering results, a total of 77 cluster labels are obtained. The Q value of the clustering module is 0.89, and the average clustering profile silhouette (S) value is 0.92, indicating that the clustering structure is significant and the results are reasonable. The aerobics cluster contains the most closely related keywords, covering mental health and stress levels. Data analysis based on existing studies reveals that aerobics has a significant impact on mental health and stress levels. Individuals participating in aerobics show obvious improvement in mental health inventory (MHI) scores (t(100) = 4.32, p<0.05). Individuals participating in aerobics present a remarkable reduction in the questionnaire evaluation of stress levels (t(100) = -3.91, p<0.05). This study’s results support aerobics’ positive effects on mental health and stress levels.

PMID:38502660 | DOI:10.1371/journal.pone.0300677