Tag: nevin manimala

JAMA Netw Open. 2023 Aug 1;6(8):e2328934. doi: 10.1001/jamanetworkopen.2023.28934.

ABSTRACT

IMPORTANCE: Medical and nonmedical cannabis use and cannabis use disorders (CUD) have increased with increasing cannabis legalization. However, the prevalence of CUD among primary care patients who use cannabis for medical or nonmedical reasons is unknown for patients in states with legal recreational use.

OBJECTIVE: To estimate the prevalence and severity of CUD among patients who report medical use only, nonmedical use only, and both reasons for cannabis use in a state with legal recreational use.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey study took place at an integrated health system in Washington State. Among 108 950 adult patients who completed routine cannabis screening from March 2019 to September 2019, 5000 were selected for a confidential cannabis survey using stratified random sampling for frequency of past-year cannabis use and race and ethnicity. Among 1688 respondents, 1463 reporting past 30-day cannabis use were included in the study.

EXPOSURE: Patient survey-reported reason for cannabis use in the past 30 days: medical use only, nonmedical use only, and both reasons.

MAIN OUTCOMES AND MEASURES: Patient responses to the Composite International Diagnostic Interview-Substance Abuse Module for CUD, corresponding to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition CUD severity (0-11 symptoms) were categorized as any CUD (≥2 symptoms) and moderate to severe CUD (≥4 symptoms). Adjusted analyses were weighted for survey stratification and nonresponse for primary care population estimates and compared prevalence of CUD across reasons for cannabis use.

RESULTS: Of 1463 included primary care patients (weighted mean [SD] age, 47.4 [16.8] years; 748 [weighted proportion, 61.9%] female) who used cannabis, 42.4% (95% CI, 31.2%-54.3%) reported medical use only, 25.1% (95% CI, 17.8%-34.2%) nonmedical use only, and 32.5% (95% CI, 25.3%-40.8%) both reasons for use. The prevalence of CUD was 21.3% (95% CI, 15.4%-28.6%) and did not vary across groups. The prevalence of moderate to severe CUD was 6.5% (95% CI, 5.0%-8.6%) and differed across groups: 1.3% (95% CI, 0.0%-2.8%) for medical use, 7.2% (95% CI, 3.9%-10.4%) for nonmedical use, and 7.5% (95% CI, 5.7%-9.4%) for both reasons for use (P = .01).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of primary care patients in a state with legal recreational cannabis use, CUD was common among patients who used cannabis. Moderate to severe CUD was more prevalent among patients who reported any nonmedical use. These results underscore the importance of assessing patient cannabis use and CUD symptoms in medical settings.

PMID:37642968 | DOI:10.1001/jamanetworkopen.2023.28934

JAMA Netw Open. 2023 Aug 1;6(8):e2330763. doi: 10.1001/jamanetworkopen.2023.30763.

ABSTRACT

IMPORTANCE: The impact of group-based prenatal care (GPNC) model in the US on the risk of gestational diabetes (GD) and related adverse obstetric outcomes is unknown.

OBJECTIVE: To determine the effects of the GPNC model on risk of GD, its progression, and related adverse obstetric outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This is a single-site, parallel-group, randomized clinical trial conducted between February 2016 and March 2020 at a large health care system in Greenville, South Carolina. Participants were individuals aged 14 to 45 years with pregnancies earlier than 21 weeks’ gestational age; follow-up continued to 8 weeks post partum. This study used an intention-to-treat analysis, and data were analyzed from March 2021 to July 2022.

INTERVENTIONS: Eligible participants were randomized to receive either CenteringPregnancy, a widely used GPNC model, with 10 group-based sessions or traditional individual prenatal care (IPNC).

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of GD diagnosed between 24 and 30 weeks of gestation. The secondary outcomes included progression to A2 GD (ie, GD treated with medications) and GD-related adverse obstetric outcomes (ie, preeclampsia, cesarean delivery, and large for gestational age). Log binomial models were performed to estimate risk differences (RDs), 95% CIs, and P values between GPNC and IPNC groups, adjusting for all baseline covariates.

RESULTS: Of all 2348 participants (mean [SD] age, 25.1 [5.4] years; 952 Black participants [40.5%]; 502 Hispanic participants [21.4%]; 863 White participants [36.8%]), 1176 participants were randomized to the GPNC group and 1174 were randomized to the IPNC group. Among all participants, 2144 (91.3%) completed a GD screening (1072 participants [91.3%] in GPNC vs 1071 [91.2%] in IPNC). Overall, 157 participants (6.7%) developed GD, and there was no difference in GD incidence between the GPNC (83 participants [7.1%]) and IPNC (74 participants [6.3%]) groups, with an adjusted RD of 0.7% (95% CI, -1.2% to 2.7%). Among participants with GD, GPNC did not reduce the risk of progression to A2 GD (adjusted RD, -6.1%; 95% CI, -21.3% to 9.1%), preeclampsia (adjusted RD, -7.9%; 95% CI, -17.8% to 1.9%), cesarean delivery (adjusted RD, -8.2%; 95% CI, -12.2% to 13.9%), and large for gestational age (adjusted RD, -1.2%; 95% CI, -6.1% to 3.8%) compared with IPNC.

CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial among medically low-risk pregnant individuals, the risk of GD was similar between participants who received GPNC intervention and traditional IPNC, indicating that GPNC may be a feasible treatment option for some patients.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02640638.

PMID:37642966 | DOI:10.1001/jamanetworkopen.2023.30763

JAMA Netw Open. 2023 Aug 1;6(8):e2331168. doi: 10.1001/jamanetworkopen.2023.31168.

ABSTRACT

IMPORTANCE: Despite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health Problems (ICD)-coded hospital discharge diagnosis for sepsis identification suffer from limited sensitivity. Also, ICD data do not allow investigation of underlying pathogens and antimicrobial resistance.

OBJECTIVES: To generate reliable epidemiological estimates by linking data from a population-based database to a reference standard of clinical medical record review.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational cohort study using a population-based administrative database including all acute care hospitals of the Scania region in Sweden in 2019 and 2020 to identify hospital-treated sepsis cases by ICD codes. From this database, clinical medical records were also selected for review within 6 strata defined by ICD discharge diagnosis (both with and without sepsis diagnosis). Data were analyzed from April to October 2022.

MAIN OUTCOMES AND MEASURES: Hospital and population incidences of sepsis, case fatality, antimicrobial resistance, and temporal dynamics due to COVID-19 were assessed, as well as validity of ICD-10 case identification methods compared with the reference standard of clinical medical record review.

RESULTS: Out of 295 531 hospitalizations in 2019 in the Scania region of Sweden, 997 patient medical records were reviewed, among which 457 had sepsis according to clinical criteria. Of the patients with clinical sepsis, 232 (51%) were female, and 357 (78%) had at least 1 comorbidity. The median (IQR) age of the cohort was 76 (67-85) years. The incidence of sepsis in hospitalized patients according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in 2019 was 4.1% (95% CI, 3.6-4.5) by medical record review. This corresponds to an annual incidence rate of 747 (95% CI, 663-832) patients with sepsis per 100 000 population. No significant increase in sepsis during the COVID-19 pandemic nor a decrease in sepsis incidence when excluding COVID-19 sepsis was observed. Few sepsis cases caused by pathogens with antimicrobial resistance were found. The validity of ICD-10-based case identification in administrative data was low.

CONCLUSIONS AND RELEVANCE: In this cohort study of sepsis epidemiology, sepsis was a considerable burden to public health in Sweden. Supplying administrative data with information from clinical medical records can help to generate reliable data on sepsis epidemiology.

PMID:37642964 | DOI:10.1001/jamanetworkopen.2023.31168

JAMA Netw Open. 2023 Aug 1;6(8):e2331264. doi: 10.1001/jamanetworkopen.2023.31264.

ABSTRACT

IMPORTANCE: Synthetic opioids, such as the fentanyl analogue and nitazene drug class, are among the fastest growing types of opioids being detected in patients in the emergency department (ED) with illicit opioid overdose (OD). However, clinical outcomes from OD of novel potent opioids (NPOs), specifically nitazenes, are unknown aside from small case series.

OBJECTIVE: To determine naloxone administration and clinical sequelae of patients who were in the ED with NPO overdose compared with fentanyl OD.

DESIGN, SETTING, AND PARTICIPANTS: This is a cohort study subgroup analysis of adults admitted to the ED and tested positive for NPOs among in the ongoing nationwide ToxIC Fentalog cohort study from 2020 to 2022. Patients who were in the ED with a presumed acute opioid OD and residual blood samples were included, and those testing positive for NPOs were analyzed. Patients were included in this analysis if their confirmatory testing was positive for an NPO analyte, such as brorphine, isotonitazene, metonitazene, and/or N-piperidinyl etonitazene. A comparison group included patients that were positive for fentanyl and devoid of any other analytes on toxicologic analysis.

EXPOSURES: Patients were exposed to NPOs, including brorphine, isotonitazene, metonitazene and/or N-piperidinyl etonitazene.

MAIN OUTCOMES AND MEASURES: The primary outcome was the total number of naloxone doses and total cumulative naloxone dose administered as part of routine clinical care following the OD. Naloxone requirements and clinical sequelae of NPO-positive patients were compared with those testing positive for fentanyl only.

RESULTS: During the study period, 2298 patients were screened, of whom 717 met inclusion criteria, 537 had complete laboratory testing data, with 11 (2.0%) positive for only fentanyl and 9 (1.7%) positive for NPOs (brorphine, isotonitazene, metonitazene, or N-piperidinyl etonitazene). The age range of patients was aged 20 to 57 years (4 males [44.4%] and 5 females [55.6%]). The NPO group received a statistically significantly higher mean (SD) number of naloxone boluses in-hospital (1.33 [1.50]) compared with the fentanyl group (0.36 [0.92]) (P = .02), which corresponded to a moderately large effect size (Cohen d = 0.78). Metonitazene overdose was associated with cardiac arrest and more naloxone doses overall. Metonitazene cases had a mean (SD) number of 3.0 (0) naloxone doses, and 2 of 2 patients (100%) with metonitazene overdoses were administered cardiopulmonary resuscitation.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients admitted to the ED with confirmed opioid overdose testing positive for NPOs, in-hospital naloxone dosing was high compared with patients who tested positive for fentanyl alone. Further study is warranted to confirm these preliminary associations.

PMID:37642962 | DOI:10.1001/jamanetworkopen.2023.31264

Environ Sci Pollut Res Int. 2023 Aug 29. doi: 10.1007/s11356-023-29367-y. Online ahead of print.

ABSTRACT

The benthic foraminiferal community is an excellent bio-indicator of pollution in coastal and marginal marine settings. Their abundance, diversity and its relationship with environmental parameters, viz. grain size, organic carbon (C_org) and trace metals concentration, from the surface sediment layer of the southwestern shelf of the Bay of Bengal, have been used to understand the marine pollution in this study. A total of 32 surface sediment samples were collected at various water depths.The samples were analysed for grain size distribution, organic matter (OM), foraminiferal and trace metals studies. Statistical analyses such as correlation matrix, PCA (Principal Component Analysis) and cluster analysis show that the foraminiferal species composition is significantly influenced by the organic carbon (C_org), Co, Pb, Zn, Cr, and Ni concentrations. The dominance of stress-tolerant species, viz. Ammonia beccarii, Ammonia tepida, Nonion faba, Bulimina marginata, Bolivina robusta, Elphidium craticulatum and Elphidium advenum, as well as less species diversity, demonstrates the elevated C_org and trace metal pollution in the marine environment.

PMID:37642911 | DOI:10.1007/s11356-023-29367-y

Breast Cancer Res Treat. 2023 Aug 29. doi: 10.1007/s10549-023-07087-8. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the performance metrics of screening mammography according to menstrual cycle week in premenopausal Asian women.

METHODS: This retrospective study included 69,556 premenopausal Asian women who underwent their first screening mammography between 2011 and 2019. The presence or absence of a breast cancer diagnosis within 12 months after the index screening mammography served as the reference standard, determined by linking the study data to the national cancer registry data. Menstrual cycles were calculated, and participants were assigned to groups according to weeks 1-4. The performance metrics included cancer detection rate (CDR), sensitivity, specificity, and positive predictive value (PPV), with comparisons across menstrual cycles.

RESULTS: Among menstrual cycles, the lowest CDR at 4.7 per 1000 women (95% confidence interval [CI], 3.8-5.8 per 1000 women) was observed in week 4 (all P < 0.05). The highest sensitivity of 72.7% (95% CI, 61.4-82.3) was observed in week 1, although the results failed to reach statistical significance. The highest specificity of 80.4% (95% CI, 79.5-81.3%) was observed in week 1 (P = 0.01). The lowest PPV of 2.2% (95% CI, 1.8-2.7) was observed in week 4 (all P < 0.05).

CONCLUSION: Screening mammography tended to show a higher performance during week 1 and a lower performance during week 4 of the menstrual cycle among Asian women. These results emphasize the importance of timing recommendations that consider menstrual cycles to optimize the effectiveness of screening mammography for breast cancer detection.

PMID:37642882 | DOI:10.1007/s10549-023-07087-8

CVIR Endovasc. 2023 Aug 29;6(1):44. doi: 10.1186/s42155-023-00389-4.

ABSTRACT

PURPOSE: Aim of this study was to analyze hospitalizations due to ruptured and non-ruptured abdominal aortic aneurysms (rAAA, nrAAA) in Germany between 2005 and 2021 to determine long-term trends in treatment and the impact of the SARS-CoV-2 pandemic.

MATERIALS AND METHODS: Fully anonymized data were available from the research data center (RDC) of the German Federal Statistical Office (Destatis). All German hospitalizations with the ICD-10 code “I71.3, rAAA” and “I71.4, nrAAA” in 2005 and 2010-2021 were analyzed.

RESULTS: We report data of a total of 202,951 hospitalizations. The number of hospitalizations increased from 2005 to 2019 (14,075 to 16,051, + 14.0%). The rate of open repair (OR) constantly decreased, whereas the rate of endovascular aortic repair (EVAR) increased until 2019. During the pandemic, the number of hospitalizations due to nrAAA dropped from 13,887 (86.5%) in 2019 to 11,278 (85.0%) in 2021. The strongest decrease of hospitalizations for AAA was observed during the first wave of the SARS-CoV-2-pandemic in spring 2020 (-25.5%).

CONCLUSION: Over the past decades, we observed an increasing number of hospitalizations due to AAA accompanied by a shift from OR to EVAR especially for nrAAA. During the lockdown measures due to the SARS-CoV-2-pandemic, a decrease in hospitalizations for nrAAA (but not for rAAA) was shown in 2020 and furthermore in 2021 with no rebound of treatment of nrAAA suggesting an accumulation of untreated AAA with a potentially increased risk of rupture.

PMID:37642825 | DOI:10.1186/s42155-023-00389-4

AIDS Behav. 2023 Aug 29. doi: 10.1007/s10461-023-04149-2. Online ahead of print.

ABSTRACT

The COVID-19 pandemic adversely affected the delivery of essential health services globally. In this study, we aimed to assess the impact of the pandemic on HIV testing and linkage services at three public health facilities in Freetown, Sierra Leone. We conducted a retrospective study to assess the impact of COVID-19 on HIV testing and linkage to treatment services (HTS) at Connaught Hospital (CH-tertiary), Lumley Government Hospital (LGH-secondary) and George Brooke Community Health Center (GBC-primary) in Freetown. Statistical analyses were conducted in Stata (16.1, StataCorp LLC, College Station, TX). Intra-pandemic HTS (2020) and HTS during recovery (2021) were compared with pre-pandemic HTS (2019). Of the 8538 people tested for HIV in the three facilities, 4929 (57.5%) visited CH. Only 2249 people were tested for HIV in 2020 compared to 3825 in 2019 (difference: – 41.2%, P < 0.001). Fewer people were also tested in 2021 (difference: – 35.6% P < 0.001). The largest reductions in testing in 2020 occurred in women (- 47.7%), children under 15 (- 95.2%), married people (- 42.6%), and CH (- 46.2%). Overall, 1369 (16.0%) people were positive for HIV; CH (878, 17.9%), LGH (469, 15.6%) and GBC (22, 3.5%). The likelihood of a positive HIV test was 26% lower in 2020 than 2019 (PR 0.74; 95% CI 0.64-0.85; P < 0.001), but 16% higher in 2021 than 2019 (PR 1.16; 95% CI 1.03-1.30; P < 0.05). Of the 1369 HIV diagnosis, 526 (38.4%) were linked to care. We found significant disruptions in HIV testing and linkage services at different levels of service delivery during the COVID-19 pandemic, underscoring the need to strengthen essential health services during public health emergencies.

PMID:37642824 | DOI:10.1007/s10461-023-04149-2

J Assist Reprod Genet. 2023 Aug 29. doi: 10.1007/s10815-023-02919-4. Online ahead of print.

ABSTRACT

PURPOSE: Poor response to ovarian stimulation (POR) typically is reflected as decreased follicular response and low estradiol (E2) levels following ovarian stimulation by FSH/HMG. Many genes are involved in oocyte maturation, and demographic features and lifestyle can affect the oocyte maturity and developmental competence. The present study was conducted to investigate the magnitude of gene expression and lifestyle habits in POR women as compared to healthy women, using different statistical and computational methods.

METHODS: Fifty women in the two groups were studied. The study groups included POR women (n = 25) with 1-9 released oocytes, and the control group (normal women, n = 25) with 9-15 released oocytes. Quantitative PCR was used to estimate the expression of FIGLA, ZAR1, WNT4, LHX8, APC, H1FOO, MOS, and DMC1 genes in granulosa cells.

RESULTS: The results showed no significant difference in the magnitude of the studied genes’ expression and linear discriminant analysis did not differentiate the studied groups based on all the genes together. Redundancy analysis (RDA) and latent factor mixed model (LFMM) results produce no significant association between the genes’ expression magnitude and the geographical variables of the patients’ local habitat. Linear discriminant analysis (LDA) of the demographic features differentiated the two groups of women.

CONCLUSION: Our results indicate that demographic features may have an effect on sample gene expression levels.

PMID:37642817 | DOI:10.1007/s10815-023-02919-4

Biol Trace Elem Res. 2023 Aug 29. doi: 10.1007/s12011-023-03821-x. Online ahead of print.

ABSTRACT

In this study macro, micro and trace elemental concentrations were measured in Eritrean acacia honey samples by Inductively Coupled Plasma Optical Emission Spectrometry (Al, B, C, K, Mg, Na, P and S) and Inductively Coupled Plasma Mass Spectrometry (As, Ba, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sr and Zn). The concentration of essential elements in the examined Eritrean acacia honeys decreased in the following order: K > P > Ca > Mg > Fe > Zn > Mn > Cu > Sr > Mo. Independent samples T test was used to determine the statistically verified differences between the two regions, but there was none; however there were remarkable differences among the measured element contents of specific honey samples. Elemental concentrations of Eritrean honeys are influenced by the characteristics of the collecting area (e.g. elevation, agricultural activities, water resources).Our samples showed low essential elemental concentration; therefore the consumption of these honeys does not contribute significantly to the nutrition reference value (NRV) (around 1% of NRV). Toxic elemental concentrations were also low; thus the calculated estimated daily intakes were much lower than the tolerable daily intakes. Consumption of these honeys presents no risk for the human body.

PMID:37642810 | DOI:10.1007/s12011-023-03821-x