Tag: nevin manimala

JMIR Public Health Surveill. 2023 Nov 30;9:e45870. doi: 10.2196/45870.

ABSTRACT

BACKGROUND: Other infectious diarrhea (OID) continues to pose a significant public health threat to all age groups in Fujian Province. There is a need for an in-depth analysis to understand the epidemiological pattern of OID and its associated risk factors in the region.

OBJECTIVE: In this study, we aimed to describe the overall epidemic characteristics and spatiotemporal pattern of OID in Fujian Province from 2005 to 2021 and explore the linkage between sociodemographic and environmental factors and the occurrence of OID within the study area.

METHODS: Notification data for OID in Fujian were extracted from the China Information System for Disease Control and Prevention. The spatiotemporal pattern of OID was analyzed using Moran index and Kulldorff scan statistics. The seasonality of and short-term impact of meteorological factors on OID were examined using an additive decomposition model and a generalized additive model. Geographical weighted regression and generalized linear mixed model were used to identify potential risk factors.

RESULTS: A total of 388,636 OID cases were recorded in Fujian Province from January 2005 to December 2021, with an average annual incidence of 60.3 (SD 16.7) per 100,000 population. Children aged <2 years accounted for 50.7% (196,905/388,636) of all cases. There was a steady increase in OID from 2005 to 2017 and a clear seasonal shift in OID cases from autumn to winter and spring between 2005 and 2020. Higher maximum temperature, atmospheric pressure, humidity, and precipitation were linked to a higher number of deseasonalized OID cases. The spatial and temporal aggregations were concentrated in Zhangzhou City and Xiamen City for 17 study years. Furthermore, the clustered areas exhibited a dynamic spreading trend, expanding from the southernmost Fujian to the southeast and then southward over time. Factors such as densely populated areas with a large <1-year-old population, less economically developed areas, and higher pollution levels contributed to OID cases in Fujian Province.

CONCLUSIONS: This study revealed a distinct distribution of OID incidence across different population groups, seasons, and regions in Fujian Province. Zhangzhou City and Xiamen City were identified as the major hot spots for OID. Therefore, prevention and control efforts should prioritize these specific hot spots and highly susceptible groups.

PMID:38032713 | DOI:10.2196/45870

JMIR Res Protoc. 2023 Nov 30;12:e47978. doi: 10.2196/47978.

ABSTRACT

BACKGROUND: Though rates of tobacco smoking have decreased consistently over the past 3 decades, cigarette use remains the top preventable cause of premature death in North America. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a medical clinic-based intervention that systematically screens parents for tobacco use and offers them direct access to evidence-based smoking cessation services. While the effectiveness of CEASE for parents who smoke has already been demonstrated in the United States, the CEASE model has not yet been tested in Canada, among parents who use e-cigarettes, or among adolescents who use cigarettes and e-cigarettes.

OBJECTIVE: We aim to demonstrate the feasibility and evaluate the preliminary effectiveness of the CEASE program for parental smoking cessation and its adapted version for adolescent smoking cessation and adolescent and parental vaping cessation.

METHODS: We will approach parents or guardians of children aged between 0 and 17 years, as well as adolescent patients aged between 14 and 17 years, from a tertiary care pediatric hospital in Montreal, Quebec, Canada, for participation in this single-blinded, pilot randomized controlled trial. Eligible participants are those who report using tobacco cigarettes or e-cigarettes at least once in the last 7 days and present to an outpatient pediatric clinic for a scheduled appointment. Our recruitment target is 100 participants: 50 parents or guardians of children aged 17 years or younger, and 50 adolescents aged between 14 and 17 years. The feasibility of implementation of the CEASE model will be measured by recruitment and retention rates for all 4 participant groups (stratified as follows: parents who use cigarettes, parents who use e-cigarettes exclusively, adolescents who use cigarettes, and adolescents who use e-cigarettes exclusively). Parent and adolescent participants within each group are randomized to the intervention and control groups using a 1:1 ratio through a computer-generated randomization list. Preliminary effectiveness outcomes include self-reported smoking and e-cigarette cessation, use of cessation resources, changes in smoking and e-cigarette use, motivation to quit, and quit attempts among participants. Participants complete electronic questionnaires on a tablet in the clinic at baseline as well as electronic follow-up questionnaires at 1, 3, and 6 months. Individuals reporting successful quit attempts are invited to provide a urine sample for cotinine testing to biochemically confirm quit. Analyses include descriptive statistics as well as exploratory trajectory analyses of smoking, e-cigarette use, and motivation to quit.

RESULTS: Research activities began in June 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 15 months.

CONCLUSIONS: There is a strong need for effective and cost-effective smoking and vaping cessation interventions for parents and adolescents. If successful, this study will help inform the preparation of a fully powered randomized controlled trial of CEASE in Canada in these populations.

TRIAL REGISTRATION: Clinicaltrials.gov NCT05366790; https://www.clinicaltrials.gov/study/NCT05366790.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47978.

PMID:38032712 | DOI:10.2196/47978

JMIR Rehabil Assist Technol. 2023 Nov 30;10:e45307. doi: 10.2196/45307.

ABSTRACT

BACKGROUND: Building up physical activity is a highly important aspect in an older patient’s rehabilitation process after hip fracture surgery. The patterns of physical activity during rehabilitation are associated with the duration of rehabilitation stay. Predicting physical activity patterns early in the rehabilitation phase can provide patients and health care professionals an early indication of the duration of rehabilitation stay as well as insight into the degree of patients’ recovery for timely adaptive interventions.

OBJECTIVE: This study aims to explore the early prediction of physical activity patterns in older patients rehabilitating after hip fracture surgery at a skilled nursing home.

METHODS: The physical activity of patients aged ≥70 years with surgically treated hip fracture was continuously monitored using an accelerometer during rehabilitation at a skilled nursing home. Physical activity patterns were described in our previous study, and the 2 most common patterns were used in this study for pattern prediction: the upward linear pattern (n=15) and the S-shape pattern (n=23). Features from the intensity of physical activity were calculated for time windows with different window sizes of the first 5, 6, 7, and 8 days to assess the early rehabilitation moment in which the patterns could be predicted most accurately. Those features were statistical features, amplitude features, and morphological features. Furthermore, the Barthel Index, Fracture Mobility Score, Functional Ambulation Categories, and the Montreal Cognitive Assessment score were used as clinical features. With the correlation-based feature selection method, relevant features were selected that were highly correlated with the physical activity patterns and uncorrelated with other features. Multiple classifiers were used: decision trees, discriminant analysis, logistic regression, support vector machines, nearest neighbors, and ensemble classifiers. The performance of the prediction models was assessed by calculating precision, recall, and F₁-score (accuracy measure) for each individual physical activity pattern. Furthermore, the overall performance of the prediction model was calculated by calculating the F₁-score for all physical activity patterns together.

RESULTS: The amplitude feature describing the overall intensity of physical activity on the first day of rehabilitation and the morphological features describing the shape of the patterns were selected as relevant features for all time windows. Relevant features extracted from the first 7 days with a cosine k-nearest neighbor model reached the highest overall prediction performance (micro F₁-score=1) and a 100% correct classification of the 2 most common physical activity patterns.

CONCLUSIONS: Continuous monitoring of the physical activity of older patients in the first week of hip fracture rehabilitation results in an early physical activity pattern prediction. In the future, continuous physical activity monitoring can offer the possibility to predict the duration of rehabilitation stay, assess the recovery progress during hip fracture rehabilitation, and benefit health care organizations, health care professionals, and patients themselves.

PMID:38032703 | DOI:10.2196/45307

Cardiovasc J Afr. 2023 Nov 20;34:1-5. doi: 10.5830/CVJA-2023-057. Online ahead of print.

ABSTRACT

OBJECTIVE: The choroidal vascularity index (CVI) is a method that measures the density of blood vessels in the choroidal layer and can be used to evaluate the effects of hypertension. In this study we aimed to investigate the relationship between epicardial fat thickness (EFT) and CVI in patients with hypertension.

METHODS: This prospective study included 112 patients diagnosed with hypertension and 120 healthy individuals. Patients’ demographic data such as age, gender, weight, height, body mass index (BMI), smoking status, and presence of coronary artery disease and diabetes mellitus were recorded. BMI was calculated by dividing a patient’s weight in kilograms by their height in metres squared. EFT was measured by echocardiography and CVI was calculated using the optical coherence tomography method.

RESULTS: The mean CVI was found to be 66.57 ± 2.21 in the patient group and 69.22 ± 2.39 in the control group and the difference was significant (p < 0.001). The mean EFT was found to be 5.23 ± 3.25 mm in the patients and 2.57 ± 1.97 mm in the control group and the difference was statistically significant (p = 0.003). According to Spearman’s correlation analysis, there was a significant positive correlation between BMI and EFT (r = 0.379, p < 0.001) and a significant negative correlation between CVI and EFT (r = -0.412, p < 0.001).

CONCLUSION: The CVI value was significantly lower and the EFT value was significantly higher in patients with hypertension compared to non-hypertensive patients. There was a significant positive correlation between EFT and BMI and a significant negative correlation between EFT and CVI.

PMID:38032688 | DOI:10.5830/CVJA-2023-057

Orbit. 2023 Nov 30:1-6. doi: 10.1080/01676830.2023.2286380. Online ahead of print.

ABSTRACT

PURPOSE: Merkel cell carcinoma of the eyelid (MCCE) is a rare yet aggressive neuroendocrine tumour associated with significant morbidity and mortality. This study aimed to investigate survival trends and demographic factors related to MCCE, 2000-2019, using the Surveillance, Epidemiology, and End Results (SEER) Program.

METHODS: Cases were analysed by demographic parameters, disease properties, and survival. Statistical analyses were performed via a dedicated computerized software package.

RESULTS: A total 349 cases of MCCE were identified, accounting for 2% of all MCC cases in the United States during that time. Of note, the incidence of MCCE remained stable over the study period (p = .35). Female patients accounted for 56% of the cases, and males for 44%. White patients accounted for 90.8% of the the cases, and Black patients for 2.9%. MCCE incidence increased with age, with the majority of patients age 85+ (p < .05). Incidence was greatest in metropolitan areas and among those with median incomes >$75,000/year. Income correlated with likelihood of MCCE diagnosis (p < .05). Analysis of 5-year survival data showed 20% of the patients died due to MCCE within 5 years of diagnosis. Of these, the majority died within one year of diagnosis.

CONCLUSIONS: Consistent with previous reports, most patients were white, female, and age 85+.Incidence correlated with metropolitan environments and median income. While most patients did not die from MCCE, majority of recorded deaths occurred within one year of diagnosis.

PMID:38032687 | DOI:10.1080/01676830.2023.2286380

Cardiovasc J Afr. 2023 Nov 22;34:1-4. doi: 10.5830/CVJA-2023-056. Online ahead of print.

ABSTRACT

We aimed to explore the predictive values of stress hyperglycaemia (SHG) and glycosylated haemoglobin (HbA_1c) levels on admission for long-term recovery of cardiac function in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PPCI). A total of 210 AMI patients were randomly selected. The levels of SHG and HbA_1c were measured on admission, and all patients were treated with PPCI and followed up for one year. According to the recovery status of cardiac function during follow up, the patients were divided into a good recovery group and a poor recovery group. At one year after treatment, there were statistically significant differences in the levels of SHG (6.75 ± 0.69 vs 7.81 ± 0.92 mmol/l) and HbA_1c (5.13 ± 0.25 vs 5.91 ± 0.39%) between the good and poor recovery groups (p < 0.05). The levels of SHG and HbA_1c were associated with long-term recovery of cardiac function (p < 0.05). The receiver operating characteristic curves were plotted, and the area under the curves of SHG and HbA_1c for predicting the long-term recovery of cardiac function were > 0.70. The levels of SHG and HbA_1c were closely associated with longterm recovery of cardiac function after PPCI in AMI patients, displaying high predictive values.

PMID:38032685 | DOI:10.5830/CVJA-2023-056

Psychol Serv. 2023 Nov 30. doi: 10.1037/ser0000824. Online ahead of print.

ABSTRACT

The posttraumatic stress disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders-5 (PCL-5; Weathers et al., 2013) is a well-validated self-report instrument intended to assess provisional diagnostic status and symptom severity of PTSD. With the recent release of the Department of Veterans Affairs measurement-based care initiative, the PCL-5 is now required to be used by VA-based PTSD Specialty Clinics to track and monitor patient progress in treatment. With the rise of telehealth modalities in response to the COVID pandemic, clinicians have turned to remote, asynchronous assessment (i.e., assessments completed without the provider present through remote platforms) as a means to provide best care to virtual patients and reduce time burden on providers. We review the psychometric properties of the PCL-5 along with relevant criticisms of the measure to provide recommendations for its optimal use through remote, asynchronous means. We also explore considerations for using remote, asynchronous assessment to assist with measurement-based care more broadly. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

PMID:38032650 | DOI:10.1037/ser0000824

JAMA Netw Open. 2023 Nov 1;6(11):e2344136. doi: 10.1001/jamanetworkopen.2023.44136.

ABSTRACT

IMPORTANCE: There is an urgent unmet need for a treatment addressing the core symptoms and associated maladaptive symptoms of autism spectrum disorder (ASD), especially in preschool populations.

OBJECTIVES: To evaluate whether treatment of children with ASD aged 3 to 6 years treated with high-protease pancreatic therapy produces long- and short-term improvements in autism-associated maladaptive behaviors.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study at 32 sites across the US used a double-blind parallel group, delayed-start design comprising a 2-week blinded placebo run-in, and a double-blind, randomized, placebo-controlled segment (12 weeks). Children were recruited into the study in 2015, with data collection continuing until 2021. The analyses were completed from June 2021 to February 2022.

INTERVENTIONS: All participants were randomly assigned to receive either 900 mg high-protease pancreatic replacement therapy or placebo with food 3 times a day for 12 weeks, followed by all receiving 900 mg high-protease pancreatic replacement therapy for 24 weeks.

MAIN OUTCOMES AND MEASURES: The primary outcome was the irritability/agitation subscale of the Aberrant Behavior Checklist (ABC-I). All potential participants were screened using the Social Communication Questionnaire (SCQ) with diagnosis confirmed by the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) for ASD and the Autism Diagnostic Inventory-Revised (ADI-R). Outcomes were measured at the conclusion of the 12-week double-blind segment and at the conclusion of the 24-week open-label segment (total 36 weeks).

RESULTS: A total of 190 participants (150 male [79%]), aged 3 to 6 (mean [SD] age, 4.5 [0.8]) years were randomized. Mixed model for repeated measures analysis performed on ABC-I demonstrated statistically significant differences of -2.49 (95% CI, -4.66 to -0.32; Cohen d = 0.364; P = .03) at the 12-week timepoint and -3.07 (95% CI, -5.81 to -0.33; Cohen d = 0.516; P = .03) at 36-week timepoint. No convergence was noted. Our high-protease pancreatic replacement (CM-AT) was well tolerated with no emergent safety concerns or related serious adverse events noted.

CONCLUSIONS AND RELEVANCE: This cohort study of preschool children sustained cumulative reduction in the maladaptive behavior of irritability in autism. This delayed-start analysis, used to demonstrate disease and condition modification, may prove to be an important tool to evaluate treatments for ASD.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02410902 and NCT02649959.

PMID:38032645 | DOI:10.1001/jamanetworkopen.2023.44136

JAMA Netw Open. 2023 Nov 1;6(11):e2344469. doi: 10.1001/jamanetworkopen.2023.44469.

ABSTRACT

IMPORTANCE: Good-quality parent-infant interactions have protective effects on infant socio-emotional and behavioral development. These interactions are especially critical for very preterm infants at risk of vulnerabilities related to immaturity. Skin-to-skin contact (SSC) has been found to improve mother-preterm infant interaction behaviors, but few studies exist regarding its benefits when initiated immediately after birth.

OBJECTIVE: To determine the effect of immediate SSC at birth for very preterm infants on mother-infant interaction quality at 4 months of corrected age.

DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis used data from the Immediate Parent-Infant Skin-to-Skin Study (IPISTOSS), a randomized clinical trial conducted between April 1, 2018, and June 30, 2021, at 3 neonatal units in Sweden and Norway. Participants included very preterm infants (28-33 gestational weeks of age) and their parents. Four-month follow-up was concluded in December 2021. Data analyses were performed on March 16 and September 18, 2023.

INTERVENTION: Infants were allocated to standard incubator care or SSC with either parent initiated at birth and continued throughout the first 6 hours after birth.

MAIN OUTCOMES AND MEASURES: The primary outcome was mother-infant interaction quality as measured with the Parent-Child Early Relational Assessment (PCERA), based on video recordings of a 5-minute free-play situation with mother-infant dyads at 4 months of corrected age. A multilevel regression analysis was performed.

RESULTS: This analysis included 71 infants (31 twins [44%]) and 56 mothers. Infants had a mean (SD) gestational age of 31 weeks 3 (1.3) days, and more than half were male (42 [59%]); mothers had a mean (SD) age of 32 (4.9) years. There were 37 infants allocated to standard care and 34 to SSC with either parent after birth. During the first 6 hours after birth, fathers provided more SSC than mothers, with a median (IQR) of 3.25 (2.25-4.5) and 0.75 (0-2.5) hours, respectively. A statistically significant difference in 1 of 5 PCERA subscales (subscale 3: infant positive affect, communicative and social skills) was observed, with higher-quality mother-infant interaction in the SSC group at 4 months (Cohen d = 0.67 [95% CI, 0.17 to 1.17]; P = .01). This effect remained significant when adjusting for primiparity, child sex, and observation setting.

CONCLUSIONS AND RELEVANCE: In this study of the effect of immediate parent-infant SSC after very preterm birth, SSC was beneficial for the mother-infant relationship. These findings suggest that immediate SSC should be supported in the clinical setting.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03521310.

PMID:38032643 | DOI:10.1001/jamanetworkopen.2023.44469

JAMA Netw Open. 2023 Nov 1;6(11):e2345138. doi: 10.1001/jamanetworkopen.2023.45138.

ABSTRACT

IMPORTANCE: Depression is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Auricular acupuncture (AA) is a simple, low-cost, and well-tolerated option, but further studies are needed to establish its efficacy and safety.

OBJECTIVE: To estimate the efficacy and safety of auricular acupuncture as a treatment for depression.

DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at 4 university research centers in Brazil, from March to July 2023. Eligible patients were adults aged 18 to 50 years whose score on the Patient Health Questionnaire-9 (PHQ-9) indicated moderate depression (score 10-14) or moderately severe depression (score 15-19). Exclusion criteria included previous application of AA, risk of suicidal ideation, or severe depression (PHQ-9 score >20). An intent-to-treat analysis and modified intent-to-treat analysis were conducted.

INTERVENTION: Participants were randomized into 2 treatment groups, which included specific AA (SA) and nonspecific AA (NSA). Both groups received 12 sessions of AA with semipermanent needles with daily stimulation twice a week over 6 weeks and were followed-up for 3 months. All participants continued with their usual care for ethical reasons. The SA group’s treatment protocol consisted of 6 acupuncture points on the auricular pavilion chosen according to the diagnosis of depression by traditional Chinese medicine (Shenmen, subcortex, heart, lung, liver, and kidney). The NSA group’s acupuncture points were the external ear, the cheek and face area, and 4 nonspecific points in the helix region unassociated with mental health symptoms. A locator device was used to confirm which areas had neuroreactive points.

MAIN OUTCOMES AND MEASURES: The primary outcome was a reduction of at least 50% in the PHQ-9 score (ie, depression recovery) at 3 months. Secondary outcomes included depression recovery at 4 and 6 weeks; depression remission (PHQ-9 score < 5) at 4 weeks, 6 weeks, and 3 months); and adverse events.

RESULTS: A total of 304 participants were screened, and 74 participants (62 women [84%]; median [IQR] age, 29 [23-27] years) were included in the intention-to-treat analysis, with 37 participants randomized to each group (SA and NSA). A total of 47 participants (64%) were followed-up through 3 months. The results showed no statistically significant difference in depressive recovery between the groups at 3 months (14 of 24 participants in the SA group [58%] vs 10 of 23 participants in the NSA group [43%]; risk ratio [RR], 1.34; 95% CI, 0.76-2.45; P = .38). The proportions of depression recovery and remission at 4 and 6 weeks based on the PHQ-9 were higher in the SA group (except for depression recovery at 6 weeks) with no statistically significant differences. However, a statistically significant difference was observed in symptom remission at 3 months (11 of 24 participants in the SA group [46%] vs 3 of 23 participants in the NSA group [13%]; RR, 1.99; 95% CI, 1.16-3.34; P = .02) in favor of SA. There were no significant differences in adverse event rates between the groups, evidencing the intervention’s safety. Most participants reported mild pain at the needle application site (33 patients [94%] in the SA group vs 32 patients [91%] in the NSA group). Five participants dropped out of the study due to adverse events.

CONCLUSIONS AND RELEVANCE: The results of this randomized clinical trial suggest that SA over 6 weeks is safe. Although there was no statistically significant difference between groups for the primary efficacy outcome, patients receiving SA did experience greater symptom remission at 3 months. A larger sample size and longer intervention are needed to further evaluate the efficacy of SA for depression.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05855421.

PMID:38032640 | DOI:10.1001/jamanetworkopen.2023.45138