Tag: nevin manimala

Swiss Med Wkly. 2023 Jul 27;153:40103. doi: 10.57187/smw.2023.40103.

ABSTRACT

OBJECTIVES: Active surveillance for low-risk prostate cancer closely monitors patients conservatively instead of the pursuit of active treatment to reduce overtreatment of insignificant disease. Since 2009, active surveillance has been recommended as the primary management option in the European Association of Urology guidelines for low-risk disease. The present study aimed to investigate the use and uptake of active surveillance over 10 years in our certified prostate cancer centre (University Hospital of Zurich) compared with those derived from the cancer registry of the canton of Zurich, Switzerland.

MATERIALS AND METHODS: We retrospectively identified all men diagnosed with low-risk prostate cancer at our institution and from the cancer registry of the canton of Zurich from 2009 to 2018. The primary treatment of each patient was recorded. Descriptive statistics were used to analyze the use of different treatments in our centre. The results were compared with those derived from the cancer registry.

RESULTS: A total of 3393 men with low-risk prostate cancer were included in this study (University Hospital of Zurich: n = 262; cancer registry: n = 3131). In the University Hospital of Zurich and cancer registry cohorts, 146 (55.7%) and 502 (16%) men underwent active surveillance, respectively. The proportions of local treatment [115 (43.9%) vs 2220 (71%)] and androgen deprivation therapy [0 (0%) vs 43 (1.4%)] were distinctly lower in the University Hospital of Zurich cohort than in the cancer registry cohort. The uptake of active surveillance over the years was high in the University Hospital of Zurich cohort (35.4% in 2009 and 88.2% in 2018) but only marginal in the cancer registry cohort (12.2% in 2009 and 16.2% in 2018).

CONCLUSION: Despite clear guideline recommendations, active surveillance for low-risk prostate cancer is still widely underused. Our analysis showed that access to a certified interdisciplinary tumour board significantly increases the use of active surveillance.

PMID:37499067 | DOI:10.57187/smw.2023.40103

Oral Dis. 2023 Jul 27. doi: 10.1111/odi.14682. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies have found associations between smoking, alcohol, radiation, body mass index (BMI), periodontitis, and the hazard of benign salivary gland neoplasms (BSGNs). Nevertheless, the etiology of BSGNs remains unclear. This study aims to assess the causal association between these modifiable factors and the BSGNs.

METHODS: Genetic instruments associated with exposures at the genome-wide significance level were selected from corresponding genome-wide association studies. The summary statistics for BSGNs were obtained from the FinnGen consortium (2445 cases and 340,054 controls). The inverse variance-weighted method was used as the primary analysis, and several sensitivity analyses were performed to test the reliability.

RESULTS: Genetically predicted higher lifetime smoking index (odds ratio [OR] = 2.10, p = 0.012) and BMI (OR = 1.58, p = 2.29 × 10^-5 ) were associated with elevated risk of BSGNs, whereas other exposures do not. Sensitivity analyses showed consistency. The causal effect of the lifetime smoking index became more significant after adjusting for BMI (OR = 2.89, p = 0.005) and alcohol consumption (OR = 2.49, p = 0.002). A slight negative association emerged for alcohol consumption with adjustment for cigarettes per day (OR = 0.53, p = 0.034) but disappeared when adjusting for cigarettes per day and BMI.

CONCLUSION: This study supports the independent causal role of lifetime smoking index and BMI in BSGNs risk.

PMID:37499050 | DOI:10.1111/odi.14682

Science. 2023 Jul 28;381(6656):404-408. doi: 10.1126/science.add8424. Epub 2023 Jul 27.

ABSTRACT

We studied the effects of exposure to reshared content on Facebook during the 2020 US election by assigning a random set of consenting, US-based users to feeds that did not contain any reshares over a 3-month period. We find that removing reshared content substantially decreases the amount of political news, including content from untrustworthy sources, to which users are exposed; decreases overall clicks and reactions; and reduces partisan news clicks. Further, we observe that removing reshared content produces clear decreases in news knowledge within the sample, although there is some uncertainty about how this would generalize to all users. Contrary to expectations, the treatment does not significantly affect political polarization or any measure of individual-level political attitudes.

PMID:37499012 | DOI:10.1126/science.add8424

Science. 2023 Jul 28;381(6656):398-404. doi: 10.1126/science.abp9364. Epub 2023 Jul 27.

ABSTRACT

We investigated the effects of Facebook’s and Instagram’s feed algorithms during the 2020 US election. We assigned a sample of consenting users to reverse-chronologically-ordered feeds instead of the default algorithms. Moving users out of algorithmic feeds substantially decreased the time they spent on the platforms and their activity. The chronological feed also affected exposure to content: The amount of political and untrustworthy content they saw increased on both platforms, the amount of content classified as uncivil or containing slur words they saw decreased on Facebook, and the amount of content from moderate friends and sources with ideologically mixed audiences they saw increased on Facebook. Despite these substantial changes in users’ on-platform experience, the chronological feed did not significantly alter levels of issue polarization, affective polarization, political knowledge, or other key attitudes during the 3-month study period.

PMID:37498999 | DOI:10.1126/science.abp9364

Psychol Rep. 2023 Jul 27:332941231191066. doi: 10.1177/00332941231191066. Online ahead of print.

ABSTRACT

For unconscious perception research, Bayesian statistics are more appropriate for assessing null awareness of masked stimuli than traditional (frequentist) statistics. This assertion is based mostly upon the theoretical features of Bayesian statistics and modeling studies. To further assess the potential advantages, we compared frequentist and Bayesian statistical tests in a masked Stroop priming experiment in which the prime stimuli were presented at varying degrees of visibility. A novel contribution was to compare a null awareness dissociation approach (i.e., stimulus awareness = 0) to a relative sensitivity approach (indirect or priming effects > direct effects) for the same data. From a null awareness perspective, the frequentist t-tests for the Stroop effect (i.e., perception) for the briefest display conditions had non-significant outcomes. Similar Bayesian t-tests were inconclusive. In contrast, the relative sensitivity dissociation approach was more interpretable, with strong evidence against unconscious perception from a single Bayesian t test. For the longer display conditions, both statistical approaches suggested large conscious perception effects. We conclude that the utility of Bayesian statistics is highly dependent upon the type of dissociation approach, with a relative sensitivity approach being more straightforward to interpret than a null awareness approach.

PMID:37498991 | DOI:10.1177/00332941231191066

J Med Internet Res. 2023 Jul 27;25:e44079. doi: 10.2196/44079.

ABSTRACT

BACKGROUND: Children’s conduct and emotional problems increased during the COVID-19 pandemic.

OBJECTIVE: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep).

METHODS: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models.

RESULTS: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=-0.01) or T3 (secondary outcome; standardized effect=-0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=-0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded.

CONCLUSIONS: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

PMID:37498669 | DOI:10.2196/44079

J Clin Psychiatry. 2023 Jul 24;84(5):22m14726. doi: 10.4088/JCP.22m14726.

ABSTRACT

Objective: Rates of postpartum depression (PPD) increased during the COVID-19 pandemic, further highlighting the need for effective, accessible treatments for PPD. While public health nurses (PHNs) can be trained to help treat PPD, it is not known if they can effectively deliver evidence-based psychotherapies online to those with PPD.

Methods: Mothers (n = 159) living in Ontario, Canada, with an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 and an infant < 12 months of age were randomized to receive a 9-week group cognitive behavioral therapy (CBT) intervention delivered by PHNs over Zoom, between October 2020 and November 2021. Experimental group participants received CBT plus treatment as usual (TAU), and control participants received TAU alone. Participants were assessed at baseline (T1), 9 weeks later (T2), and 6 months after T2 (T3). Primary outcomes were changes in EPDS score and current major depressive disorder (MDD) as measured by the Mini International Neuropsychiatric Interview. Secondary outcomes included worry, social support, the mother-infant relationship, and infant temperament.

Results: At T2, experimental group participants showed clinically and statistically significant reductions on the EPDS (d = 0.65) and decreases in postpartum worry (d = 0.38) and rejection and pathological anger toward their infant (d = 0.44). They were also less likely to meet diagnostic criteria for current MDD compared to control participants (OR = 5.09; 95% CI, 1.18-21.98; number needed to treat [NNT: 3.7]). These improvements remained stable 6 months later (T3).

Conclusions: PHNs can be trained to deliver effective online group CBT for PPD to reduce depression and worry and improve aspects of the mother-infant relationship, and they represent an important way to increase access to effective treatment for PPD.

Trial Registration: ClinicalTrials.gov identifier: NCT04928742.

PMID:37498661 | DOI:10.4088/JCP.22m14726

Urol Pract. 2023 Jul 27:101097UPJ0000000000000435. doi: 10.1097/UPJ.0000000000000435. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess racial and ethnic disparities in the use of prostate biopsy or magnetic resonance imaging (MRI) following an elevated prostate-specific antigen (PSA) result.

DESIGN: Retrospective evaluation of insurance claims from Optum’s de-identified Clinformatics Data Mart Database from January 1, 2011 to December 31, 2017.

SETTING: Large commercially insured cohort from across the United States.

PARTICIPANTS: All male enrollees over 40 years old receiving an elevated PSA result with no prior prostate biopsy or MRI and no confirmed urinary tract infection within 6 weeks of PSA test.

RESULTS: 765,409 participants met inclusion criteria with 43,711 (5.71%) receiving a PSA result above 4ng/mL. Of these, 7,399 received either a prostate biopsy or MRI within 180 days. Men between ages 40-54 (29.48%) were most likely to receive prostate biopsy or MRI after an elevated PSA, followed by those between 55-64 (24.91%), 65-74 (18.56%), 75-84 (6.33%), and above 85 (3.62%). Compared to White patients, Black patients were more likely to receive either a prostate biopsy or MRI (OR: 1.16 [95% CI: 1.01, 1.32]) following an elevated PSA level, while Asian (OR: 0.72 [0.54, 0.96]) and Hispanic (OR: 0.83 [0.70, 0/97]) patients were less likely.

CONCLUSIONS: and Relevance: Physicians appear to be following the reported statistical incidence of prostate cancer by race and ethnicity when using prostate biopsy or MRI for patients with elevated PSA levels. These results demonstrate the importance of publishing statistical data on disease incidence by race and ethnicity for informing physicians’ decision-making.

PMID:37498656 | DOI:10.1097/UPJ.0000000000000435

Perfusion. 2023 Jul 27:2676591231189941. doi: 10.1177/02676591231189941. Online ahead of print.

ABSTRACT

BACKGROUND: The effectiveness of a concomitant intra-aortic balloon pump (IABP) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) intervention in acute myocardial infarction with cardiogenic shock (AMICS) patients is contested in the literature. This study sought to compare short-term mortality weaning rate from VA-ECMOin AMICS cases.

METHODS: We conducted a literature review and compared the primary and secondary endpoints in the following treatment groups of AMICS patients: (1) VA-ECMO plus IABP vs. IABP alone and (2) VA-ECMO plus IABP vs. VA-ECMO alone. The primary endpoint was in-hospital all-cause mortality; while 30-days mortality, weaning from VA-ECMO, and vascular complications comprised secondary endpoints.

RESULTS: VA-ECMO concomitant with IABP was administered to 3,580 (76.4%) patients, while IABP alone and VA-ECMO alone treatments accounted for 1.7% and 21.9% of the patients, respectively. We found that in-hospital mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (odds ratio (OR) = 0.52; 95% Confidence Interval (CI) = 0.21-1.31; I-squared statistic (I² = 30%) or IABP alone (OR = 0.20; 95% CI = 0.08-0.55; I² = 0%). Additionally, 30-days mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 0.31; 95% CI = 0.25-0.40; I² = 0%) or IABP alone (OR = 0.24; 95% CI = 0.11-0.50; I² = 0%). A significant difference was observed in weaning from VA-ECMO in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 1.91; 95% CI = 1.09-3.33; I² = 0%).

CONCLUSION: In-hospital and 30-days mortality were significantly lower in AMICS patients treated with VA-ECMO plus IABP vs. VA-ECMO alone or IABP alone. VA-ECMO with concomitant IABP could increase the proportion of patients weaned from VA-ECMO, significantly reducing in-hospital mortality, without increasing complications.

PMID:37498618 | DOI:10.1177/02676591231189941

JAMA Netw Open. 2023 Jul 3;6(7):e2325914. doi: 10.1001/jamanetworkopen.2023.25914.

ABSTRACT

IMPORTANCE: Cardiometabolic parameters are established risk factors for COVID-19 severity. The identification of causal or protective biomarkers for COVID-19 severity may facilitate the development of novel therapies.

OBJECTIVE: To identify protein biomarkers that promote or reduce COVID-19 severity and that mediate the association of cardiometabolic risk factors with COVID-19 severity.

DESIGN, SETTING, AND PARTICIPANTS: This genetic association study using 2-sample mendelian randomization (MR) was conducted in 2022 to investigate associations among cardiometabolic risk factors, circulating biomarkers, and COVID-19 hospitalization. Inputs for MR included genetic and proteomic data from 4147 participants with dysglycemia and cardiovascular risk factors collected through the Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Genome-wide association study summary statistics were obtained from (1) 3 additional independent plasma proteome studies, (2) genetic consortia for selected cardiometabolic risk factors (including body mass index [BMI], type 2 diabetes, type 1 diabetes, and systolic blood pressure; all n >10 000), and (3) the COVID-19 Host Genetics Initiative (n = 5773 hospitalized and 15 497 nonhospitalized case participants with COVID-19). Data analysis was performed in July 2022.

EXPOSURES: Genetically determined concentrations of 235 circulating proteins assayed with a multiplex biomarker panel from the ORIGIN trial for the initial analysis.

MAIN OUTCOMES AND MEASURES: Hospitalization status of individuals from the COVID-19 Host Genetics Initiative with a positive COVID-19 test result.

RESULTS: Among 235 biomarkers tested in samples totaling 22 101 individuals, MR analysis showed that higher kidney injury molecule-1 (KIM-1) levels reduced the likelihood of COVID-19 hospitalization (odds ratio [OR] per SD increase in KIM-1 levels, 0.86 [95% CI, 0.79-0.93]). A meta-analysis validated the protective association with no observed directional pleiotropy (OR per SD increase in KIM-1 levels, 0.91 [95% CI, 0.88-0.95]). Of the cardiometabolic risk factors studied, only BMI was associated with KIM-1 levels (0.17 SD increase in biomarker level per 1 kg/m2 [95% CI, 0.08-0.26]) and COVID-19 hospitalization (OR per 1-SD biomarker level, 1.33 [95% CI, 1.18-1.50]). Multivariable MR analysis also revealed that KIM-1 partially mitigated the association of BMI with COVID-19 hospitalization, reducing it by 10 percentage points (OR adjusted for KIM-1 level per 1 kg/m2, 1.23 [95% CI, 1.06-1.43]).

CONCLUSIONS AND RELEVANCE: In this genetic association study, KIM-1 was identified as a potential mitigator of COVID-19 severity, possibly attenuating the increased risk of COVID-19 hospitalization among individuals with high BMI. Further studies are required to better understand the underlying biological mechanisms.

PMID:37498601 | DOI:10.1001/jamanetworkopen.2023.25914