Tag: nevin manimala

Chin Med J (Engl). 2023 Mar 15. doi: 10.1097/CM9.0000000000002341. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend hepatocellular carcinoma (HCC) screening in high-risk populations. However, the ideal HCC screening interval and screening modality have not been determined. This study aimed to compare the screening efficacy among different modalities with various intervals.

METHODS: PubMed and other nine databases were searched through June 30, 2021. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Survival rates were also pooled using RR with 95% CIs because most eligible studies only provided the number of survival patients instead of hazard ratio.

RESULTS: In all, 13 studies were included. Two random controlled trials (RCTs) and six cohort studies compared screening intervals for ultrasonography (US) screening and found no differences between shorter (3- or 4-month) and longer (6- or 12-month) screening intervals in terms of early HCC proportion, HCC Significant mortality, 1-year survival rate; screening at 6-month interval significantly increased the proportion of early HCC (RR = 1.17, 95% CI: 1.08-1.26) and prolonged the 5-year survival rate (RR = 1.39, 95% CI: 1.07-1.82) relative to the 12-month interval results. Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B, which indicated no statistical differences in the proportion of early HCC (RR = 0.89, 95% CI: 0.40-1.96) and HCC mortality (RR = 0.69, 95% CI: 0.23-2.09) between the biannual US and annual computed tomography (CT screening). Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging (MRI) (RR = 0.60, 95% CI: 0.37-0.97) and biannual US combined with annual CT (RR = 1.31, 95% CI: 1.13-1.51) screening. The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US (RR = 1.08, 95% CI: 1.00-1.23) group.

CONCLUSIONS: The evidence suggests that 6 months may be the best HCC screening interval for US screening. The effectiveness of CT and MRI is better than US during same screening intervals. However, MRI and CT are more expensive than US, and CT also can increase the risk of radiation exposure. The selection of CT or MRI instead of US should be carefully considered.

PMID:36921104 | DOI:10.1097/CM9.0000000000002341

Am J Respir Crit Care Med. 2023 Mar 15. doi: 10.1164/rccm.202209-1653OC. Online ahead of print.

ABSTRACT

RATIONALE: Lung disease is the major cause of morbidity and mortality in persons with cystic fibrosis (pwCF). Variability in CF lung disease has substantial non-CFTR genetic influence. Identification of genetic modifiers has prognostic and therapeutic importance.

OBJECTIVES: Identify genetic modifier loci and genes/pathways associated with pulmonary disease severity.

METHODS: Whole genome sequencing (WGS) data on 4,248 unique pwCF with pancreatic insufficiency (PI) and lung function measures were combined with imputed genotypes from an additional 3,592 PI patients from the US, Canada, and France. This report describes association of ~15.9 million single nucleotide polymorphisms (SNPs), using the quantitative Kulich Normal Residual Mortality Adjusted (KNoRMA) lung disease phenotype in 7,840 pwCF using pre-modulator lung function data.

MEASUREMENTS AND MAIN RESULTS: Testing included common and rare SNPs, transcriptome-wide association, gene level, and pathway analyses. Pathway analyses identified novel associations with genes that have key roles in organ development, and we hypothesize these genes may relate to dysanapsis and/or variability in lung repair. Results confirmed and extended previous GWAS findings. These WGS data provide finely mapped genetic information to support mechanistic studies. No novel primary associations with common single variants or with rare variants were found. Multi-locus effects at chr5p13 (SLC9A3/CEP72) and chr11p13 (EHF/APIP) were identified. Variant effect size estimates at associated loci were consistently ordered across the cohorts, indicating possible age or birth cohort effects.

CONCLUSIONS: This pre-modulator genomic, transcriptomic, and pathway association study of 7,840 pwCF will facilitate mechanistic and post-modulator genetic studies and, development of novel therapeutics for CF lung disease.

PMID:36921087 | DOI:10.1164/rccm.202209-1653OC

Health Rep. 2023 Mar 15;34(3):3-14. doi: 10.25318/82-003-x202300300001-eng.

ABSTRACT

BACKGROUND: As Canada continues to experience an opioid crisis, it is important to understand the intersection between the demographic, socioeconomic and service use characteristics of those experiencing opioid overdoses to better inform prevention and treatment programs.

DATA AND METHODS: The Statistics Canada British Columbia Opioid Overdose Analytical File (BCOOAF) represents people’s opioid overdoses between January 2014 and December 2016 (n = 13,318). The BCOOAF contains administrative health data from British Columbia linked to Statistics Canada data, including on health, employment, social assistance and police contacts. Cluster analysis was conducted using the k-prototypes algorithm.

RESULTS: The results revealed a six-cluster solution, composed of three groups (A, B and C), each with two distinct clusters (1 and 2). Individuals in Group A were predominantly male, used non-opioid prescription medications and had varying levels of employment. Individuals in Cluster A1 were employed, worked mostly in construction, had high incomes and had a high rate of fatal overdoses, while individuals in Cluster A2 were precariously employed and had varying levels of income. Individuals in Group B were predominantly female; were mostly taking prescription opioids, with about one quarter or less receiving opioid agonist treatment (OAT); mostly had precarious to no employment; and had low to no income. People in Cluster B1 were primarily middle-aged (45 to 65 years) and on social assistance, while people in Cluster B2 were older, more frequently used health services and had no social assistance income. Individuals in Group C were primarily younger males aged 24 to 44 years, with higher prevalence of having experienced multiple overdoses, were medium to high users of health care services, were mostly unemployed and were recipients of social assistance. Most had multiple contacts with police. Those in Cluster C1 predominantly had no documented use of prescription opioid medications, and all had no documented OAT, while all individuals in Cluster C2 were on OAT.

INTERPRETATION: The application of machine learning techniques to a multidimensional database enables an intersectional approach to study those experiencing opioid overdoses. The results revealed distinct patient profiles that can be used to better target interventions and treatment.

PMID:36921072 | DOI:10.25318/82-003-x202300300001-eng

Ergonomics. 2023 Mar 15:1-28. doi: 10.1080/00140139.2023.2191908. Online ahead of print.

ABSTRACT

Quantifying the trunk flexion angles at which wearable support systems (exoskeletons/exosuits) provide substantial trunk extension moment during posture maintenance tasks (such as those seen in surgical environments) can provide a deeper understanding of this potential intervention strategy. Understanding how time (i.e., adaptation/learning) might impact the reliance on wearable support is also of value. Sixteen participants were asked to maintain specific trunk flexion angles (range 0°- 60°) with and without an exosuit system while erector spinae and rectus abdominis muscle activity were captured using surface electromyography. The effects of the exosuit showed a statistically significant (p < 0.007) effect on the activity of the erector spinae muscles at 10°-60° – an effect that became ‘large’ (Cohen’s d = 0.87) after 20° of trunk flexion. There were no meaningful time-dependent trends in the levels of muscle activation indicating there was no adaptation/learning effect of the exosuit in the task studied.

PMID:36921063 | DOI:10.1080/00140139.2023.2191908

JMIR Form Res. 2023 Mar 15;7:e43334. doi: 10.2196/43334.

ABSTRACT

BACKGROUND: Heated tobacco products (HTPs), including I Quit Ordinary Smoking (IQOS), are new tobacco products that use an electronic device to heat compressed tobacco leaves to generate an aerosol for consumers to inhale. Marketing of HTPs is prevalent on Instagram, a popular social media platform.

OBJECTIVE: This study aims to characterize posts related to HTPs on Instagram and their associations with user engagement.

METHODS: Through the Instagram application programming interface, 979 Instagram posts were collected using keywords related to HTPs, such as “IQOS” and “heat-not-burn.” Among them, 596 posts were related to IQOS and other HTP marketing. The codebook was developed from a randomly selected 200 posts on the post content by hand coding, which was applied to the remaining 396 Instagram posts. Summary statistics were calculated, and statistical hypothesis testing was conducted to understand the popularity of Instagram posts on HTPs. Negative binomial regression models were applied to identify Instagram post characteristics associated with user engagement (eg, count).

RESULTS: Among Instagram posts related to HTP marketing (N=596), “product display” was dominant (n=550, 92.28%), followed by “brand promotion” (n=41, 6.88%), and “others” (n=5, 0.84%). Among posts within “product display,” “device only” was the most popular (n=338, 61.45%), followed by “heatstick only” (n=80, 14.55%), “accessory” (n=66, 12%), “device and heatstick” (n=56, 10.18%), and “capsule” (n=10, 1.82%). A univariate negative binomial regression model with pairwise comparisons across “product display” types showed that the number of likes for posts with HTP heatsticks was significantly lower compared to posts with HTP devices, accessories, and device-heatstick sets. Multivariate negative binomial regression models showed that HTP-related Instagram posts with a model or lifestyle elements (;=.60, 95% CI 0.36-0.84) or without obvious product advertising information (=.69, 95% CI 0.49-0.89) received more likes.

CONCLUSIONS: It is shown that posts with product displays were dominant among HTP-related posts on Instagram. Posts with model or lifestyle elements are associated with high user engagement, which might be one of the web-based marketing strategies of HTPs.

PMID:36920463 | DOI:10.2196/43334

J Med Internet Res. 2023 Mar 15;25:e41793. doi: 10.2196/41793.

ABSTRACT

BACKGROUND: Despite extensive debates about the mental health impacts of the use of social networking sites (SNSs), including WeChat, the association and mechanisms between social interaction of WeChat use intensity and antenatal depression are unclear.

OBJECTIVE: We aimed to test the mediating roles of upward social comparison on social interaction of WeChat and rumination in the association between social interaction of WeChat use intensity and antenatal depression.

METHODS: A cross-sectional survey was conducted in four hospitals with the self-reported measures of social interaction of WeChat use intensity, upward social comparison on social interaction of WeChat, rumination, antenatal depression, and control variables. The mediation analysis was performed through Model 6 from the PROCESS macro 4.0 in SPSS 26.

RESULTS: Results from 2661 participants showed that antenatal depression was unrelated to social interaction of WeChat use intensity (P=.54), but was significantly positively related to the attitude toward social interaction of WeChat (P=.01). The direct effect of attitude toward social interaction of WeChat use on antenatal depression was not statistically significant (β=-.03, P=.05). The results supported an indirect relationship between attitude toward social interaction of WeChat use and antenatal depression via (1) upward social comparison on social interaction of WeChat (indirect effect value=0.04, 95% CI 0.03 to 0.06); (2) rumination (indirect effect value=-0.02, 95% CI -0.04 to -0.01); and (3) upward social comparison on social interaction of WeChat and rumination in sequence (indirect effect value=0.07, 95% CI 0.06 to 0.08).

CONCLUSIONS: Our findings highlight the necessity of focusing on attitudes toward SNS use, and the importance of upward social comparison and rumination in understanding the effect of SNS use on antenatal depression.

PMID:36920458 | DOI:10.2196/41793

JMIR Cancer. 2023 Mar 15;9:e42890. doi: 10.2196/42890.

ABSTRACT

BACKGROUND: The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age.

OBJECTIVE: Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population.

METHODS: We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015.

RESULTS: We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96% vs 21.22%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7% and 58.36%; P<.001).

CONCLUSIONS: Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates.

PMID:36920453 | DOI:10.2196/42890

JMIR Form Res. 2023 Mar 15;7:e41685. doi: 10.2196/41685.

ABSTRACT

BACKGROUND: Accurate measurement of daily physical activity (PA) is important as PA is linked to health outcomes in older adults and people living with complex health conditions. Wrist-worn accelerometers are widely used to estimate PA intensity, including walking, which composes much of daily PA. However, there is concern that wrist-derived PA data in these cohorts is unreliable due to slow gait speed, mobility aid use, disease-related symptoms that impact arm movement, and transient activities of daily living. Despite the potential for error in wrist-derived PA intensity estimates, their use has become ubiquitous in research and clinical application.

OBJECTIVE: The goals of this work were to (1) determine the accuracy of wrist-based estimates of PA intensity during known walking periods in older adults and people living with cerebrovascular disease (CVD) or neurodegenerative disease (NDD) and (2) explore factors that influence wrist-derived intensity estimates.

METHODS: A total of 35 older adults (n=23 with CVD or NDD) wore an accelerometer on the dominant wrist and ankle for 7 to 10 days of continuous monitoring. Stepping was detected using the ankle accelerometer. Analyses were restricted to gait bouts ≥60 seconds long with a cadence ≥80 steps per minute (LONG walks) to identify periods of purposeful, continuous walking likely to reflect moderate-intensity activity. Wrist accelerometer data were analyzed within LONG walks using 15-second epochs, and published intensity thresholds were applied to classify epochs as sedentary, light, or moderate-to-vigorous physical activity (MVPA). Participants were stratified into quartiles based on the percent of walking epochs classified as sedentary, and the data were examined for differences in behavioral or demographic traits between the top and bottom quartiles. A case series was performed to illustrate factors and behaviors that can affect wrist-derived intensity estimates during walking.

RESULTS: Participants averaged 107.7 (SD 55.8) LONG walks with a median cadence of 107.3 (SD 10.8) steps per minute. Across participants, wrist-derived intensity classification was 22.9% (SD 15.8) sedentary, 27.7% (SD 14.6) light, and 49.3% (SD 25.5) MVPA during LONG walks. All participants measured a statistically lower proportion of wrist-derived activity during LONG walks than expected (all P<.001), and 80% (n=28) of participants had at least 20 minutes of LONG walking time misclassified as sedentary based on wrist-derived intensity estimates. Participants in the highest quartile of wrist-derived sedentary classification during LONG walks were significantly older (t₁₆=4.24, P<.001) and had more variable wrist movement (t₁₆=2.13, P=.049) compared to those in the lowest quartile.

CONCLUSIONS: The current best practice wrist accelerometer method is prone to misclassifying activity intensity during walking in older adults and people living with complex health conditions. A multidevice approach may be warranted to advance methods for accurately assessing PA in these groups.

PMID:36920452 | DOI:10.2196/41685

Environ Health Perspect. 2023 Mar;131(3):37010. doi: 10.1289/EHP11095. Epub 2023 Mar 15.

ABSTRACT

BACKGROUND: Numerous epidemiological studies have documented the adverse health impact of long-term exposure to fine particulate matter [particulate matter ≤2.5μm in aerodynamic diameter (PM2.5)] on mortality even at relatively low levels. However, methodological challenges remain to consider potential regulatory intervention’s complexity and provide actionable evidence on the predicted benefits of interventions. We propose the parametric g-computation as an alternative analytical approach to such challenges.

METHOD: We applied the parametric g-computation to estimate the cumulative risks of nonaccidental death under different hypothetical intervention strategies targeting long-term exposure to PM2.5 in the Canadian Community Health Survey cohort from 2005 to 2015. On both relative and absolute scales, we explored the benefits of hypothetical intervention strategies compared with the natural course that a) set the simulated exposure value at each follow-up year to a threshold value if exposure was above the threshold (8.8μg/m3, 7.04μg/m3, 5μg/m3, and 4μg/m3), and b) reduced the simulated exposure value by a percentage (5% and 10%) at each follow-up year. We used the 3-y average PM2.5 concentration with 1-y lag at the postal code of respondents’ annual mailing addresses as their long-term exposure to PM2.5. We considered baseline and time-varying confounders, including demographics, behavior characteristics, income level, and neighborhood socioeconomic status. We also included the R syntax for reproducibility and replication.

RESULTS: All hypothetical intervention strategies explored led to lower 11-y cumulative mortality risks than the estimated value under the natural course without intervention, with the smallest reduction of 0.20 per 1,000 participants (95% CI: 0.06, 0.34) under the threshold of 8.8μg/m3, and the largest reduction of 3.40 per 1,000 participants (95% CI: –0.23, 7.03) under the relative reduction of 10% per interval. The reductions in cumulative risk, or numbers of deaths that would have been prevented if the intervention was employed instead of maintaining the status quo, increased over time but flattened toward the end of the follow-up period. Estimates among those ≥65 years of age were greater with a similar pattern. Our estimates were robust to different model specifications.

DISCUSSION: We found evidence that any intervention further reducing the long-term exposure to PM2.5 would reduce the cumulative mortality risk, with greater benefits in the older population, even in a population already exposed to low levels of ambient PM2.5. The parametric g-computation used in this study provides flexibilities in simulating real-world interventions, accommodates time-varying exposure and confounders, and estimates adjusted survival curves with clearer interpretation and more information than a single hazard ratio, making it a valuable analytical alternative in air pollution epidemiological research. https://doi.org/10.1289/EHP11095.

PMID:36920446 | DOI:10.1289/EHP11095

Environ Sci Technol. 2023 Mar 15. doi: 10.1021/acs.est.2c07216. Online ahead of print.

ABSTRACT

Identifying phosphorus (P) sources is critical for solving eutrophication and controlling P in aquatic environments. Phosphate oxygen isotopes (δ¹⁸O_p) have been used to trace P sources. However, the application of this method has been greatly restricted due to δ¹⁸O_P values from the potential source having wide and overlapping ranges. In this research, P sources were traced by combining δ¹⁸O_p with multiple stable isotopes of nitrogen (δ¹⁵N), hydrogen (δD), and dissolved inorganic carbon (δ¹³C). Then, a Bayesian-based Stable Isotope Analysis in R (SIAR) model and IsoSource model were used to estimate the proportional contributions of the potential sources in the Tuojiang River. δ¹⁸O_p was not in equilibrium with ambient water, and statistically significant differences in the δ¹⁸O_p values were found between the potential sources, indicating that δ¹⁸O_p can be used to trace the P sources. δ¹⁵N, δD, and δ¹³C could assist δ¹⁸O_p in identifying the main sources of P. The SIAR and IsoSource models suggested that industrial and domestic sewage was the largest contributor, followed by phosphate rock and phosphogypsum and agricultural sewage. The uncertainty of the calculation results of the SIAR model was lower than that of the IsoSource model. These findings provide new insights into tracing P sources using multiple stable isotopes in watersheds.

PMID:36920429 | DOI:10.1021/acs.est.2c07216