Tag: nevin manimala

J Intellect Disabil Res. 2023 Apr 17. doi: 10.1111/jir.13033. Online ahead of print.

ABSTRACT

BACKGROUND: Individuals with Down syndrome (DS) exhibit deficits in static and dynamic balance abilities and maladaptive functions. This study aimed to determine the effectiveness of dance movement therapy (DMT) group intervention in individuals with DS.

METHODS: The 31 participating individuals with DS, aged 5-29 years, were randomly divided into intervention (n = 16) and control (n = 15) groups. Posturography was used for static balance measurement, timed up and go test for dynamic balance measurement and the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire for adaptive function and behavioural problem measurement in participants before and after the DMT interventions. The intervention group underwent 60-min DMT intervention once a week for 10 times, while the control group had usual daily activities.

RESULTS: The results revealed a statistically significant difference and large effect sizes in dynamic balance [(f(1, 29) = 4.52, P = 0.04, η_p² = 0.14)] in the intervention group compared with the control group. There were no statistically significant differences in static balance and ASEBA scores between the groups.

CONCLUSIONS: This study found that the DMT interventions helped to improve the dynamic balance in individuals with DS.

PMID:37066677 | DOI:10.1111/jir.13033

J Intellect Disabil Res. 2023 Apr 17. doi: 10.1111/jir.13031. Online ahead of print.

ABSTRACT

BACKGROUND: We aim to investigate the relationship between bone mass in a sample of Brazilian individuals with DS and handgrip strength, body mass index (BMI) and physical exercise.

METHODS: Dual-energy X-ray emission densitometry analysis of bone mass in 26 individuals with DS (8 men and 18 women with a mean age of 30.7 ± 10.3 years) was conducted. Additionally, weight and height were measured to determine BMI, palmar grip strength was measured using a Jammar dynamometer®, and physical activity was classified using the International Physical Activity Questionnaire (IPAQ).

RESULTS: In this sample, 2/15 (13.3%) individuals with age between 18 to 29 years had low BMD in the spine; 2/8 (25%) of those with age between 30 and 39 years also had low BMD in the spine and 2/3 (66.6%) with age ≥40 had low BMD in the femur. There were significant correlations between palmar grip strength and Z femoral neck score in women (P = 0.02) and between BMI and Z femoral neck score in men (P = 0.04). All other correlations lacked statistical significance (P > 0.05).

CONCLUSIONS: Brazilian patients with DS showed a high prevalence of low bone mass. Traditional factors such as muscle strength, BMI and physical activity appear to have little effect on bone mineral density in this population.

PMID:37066674 | DOI:10.1111/jir.13031

J Hand Surg Eur Vol. 2023 Apr 17:17531934231166343. doi: 10.1177/17531934231166343. Online ahead of print.

ABSTRACT

This study primarily aimed to report the outcome of the arthroscopic cancellous bone grafting technique for treating scaphoid nonunion. The secondary aim was to compare the bone union rate and time, and the ability to correct the angulation of the scaphoid, between arthroscopically treated patients (n = 27), and patients treated with open cancellous bone grafting (n = 27). Nine surgeons (two in the arthroscopic and seven in the open group) with Level III experience operated on the patients. The pain score, grip strength and Quick Disability of the Arm, Shoulder and Hand score improved significantly after the arthroscopic treatment (p = 0.0001). Arthroscopic cancellous bone grafting achieved union in 25 out of 27 patients. A retrospective comparison with open cancellous bone grafting showed four nonunions. Arthroscopically treated patients healed 5.4 weeks faster compared with the open group (p = 0.033). Patients treated with open grafting had a higher risk of failure (odds ratio = 2.17), although this was not found significant (p = 0.39). The open method corrected the angulation deformity better (dorsal cortical angle correction of 4°) than the arthroscopic method (dorsal cortical angle correction of 1°), but this was not statistically significant neither within the groups (p = 0.55, p = 0.87) nor postoperatively between the groups (p = 0.98). The height-to-length ratio was not different before and after the surgery for the arthroscopic group (p = 0.44) and the open group (p = 0.27), or postoperatively between the groups (p = 0.44).Level of evidence: III.

PMID:37066665 | DOI:10.1177/17531934231166343

BJPsych Open. 2023 Apr 17;9(3):e71. doi: 10.1192/bjo.2023.47.

ABSTRACT

BACKGROUND: Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date, there are no general population studies on their joint prevalence and association.

AIMS: To estimate the joint prevalence of stroke and psychosis and their statistical association using nationally representative psychiatric epidemiology studies from two high-income countries (the UK and the USA) and two middle-income countries (Chile and Colombia) and, subsequently, in a combined-countries data-set.

METHOD: Prevalences were calculated with 95% confidence intervals. Statistical associations between stroke and psychosis and between stroke and psychotic symptoms were tested using regression models. Overall estimates were calculated using an individual participant level meta-analysis on the combined-countries data-set. The analysis is available online as a computational notebook.

RESULTS: The overall prevalence of probable psychosis in stroke was 3.81% (95% CI 2.34-5.82) and that of stroke in probable psychosis was 3.15% (95% CI 1.94-4.83). The odds ratio of the adjusted association between stroke and probable psychosis was 3.32 (95% CI 2.05-5.38). On the individual symptom level, paranoia, hallucinated voices and thought passivity delusion were associated with stroke in the unadjusted and adjusted analyses.

CONCLUSIONS: Rates of association between psychosis and stroke suggest there is likely to be a high clinical need group who are under-researched and may be poorly served by existing services.

PMID:37066638 | DOI:10.1192/bjo.2023.47

BJPsych Open. 2023 Apr 17;9(3):e69. doi: 10.1192/bjo.2023.46.

ABSTRACT

BACKGROUND: Cognitive stimulation therapy (CST) is the only non-pharmacological, treatment for dementia recommended by the UK National Institute for Health and Care Excellence, following multiple international trials demonstrating beneficial cognitive outcomes in people with mild-to-moderate dementia. However, there is limited understanding of whether treatment prognosis is influenced by sociodemographic and clinical variables (such as dementia subtype and gender), information which could inform clinical decision-making.

AIM: We describe the protocol for a systematic review and individual patient data meta-analysis assessing the prognostic factors related to CST. In publishing this protocol, we hope to increase the transparency of our work, and keep healthcare professionals aware of the latest evidence for effective CST.

METHOD: A systematic review will be conducted with searches of the bibliographic databases Medline, EMBASE and PsycINFO, from inception to 7 February 2023. Studies will be included if they are clinical trials of CST, use the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (gold-standard measure of cognition in dementia in clinical trials) and include participants with mild-to-moderate dementia. Following harmonisation of the data-set, mixed-effect models will be constructed to explore the relationship between the prognostic indicators and change scores post-treatment.

CONCLUSIONS: This is the first individual patient data meta-analyses on CST, and has the potential to significantly optimise patient care. Previous analyses suggest people with advanced dementia could benefit more from CST treatment. Given that CST is currently used post-diagnosis in people with mild-to-moderate dementia, the implications of confirming this finding, among identifying other prognostic indicators, are profound.

PMID:37066632 | DOI:10.1192/bjo.2023.46

J Genet Couns. 2023 Apr 17. doi: 10.1002/jgc4.1714. Online ahead of print.

ABSTRACT

Noninvasive prenatal screening (NIPS), using placental cell-free DNA from a maternal blood sample, is currently the most sensitive and specific screening tool for detecting common fetal aneuploidies. The aim of this study was to compare the rates of “atypical” single nucleotide polymorphism (SNP)-based NIPS results and subsequent pregnancy outcomes between Arab American and non-Arab American patients. We conducted a retrospective cohort study of pregnant Arab and non-Arab American patients who had SNP-based NIPS performed between September 2018 and January 2021 at an urban health system in Michigan. The rate of “atypical” results and other perinatal outcomes were compared between groups using descriptive statistics. “Atypical” results due to multifetal gestations, either undisclosed or unknown at time of ordering, were excluded. Five thousand eight hundred and seventy-three patients underwent SNP-based NIPS: 771 (13.1%) were identified as Arab American, 5102 (86.9%) were non-Arab American, and 49 (0.8%) patients received “atypical” results. Arab patients represented only 13.1% of patients screened (771/5873) but had a significantly higher rate of “atypical” results than non-Arab American patients (17/771 [2.2%] vs. 32/5102 [0.6%]; p < 0.001). Of the 17 Arab patients with “atypical” results, 9 (52.9%) were in known consanguineous relationships. No major congenital anomalies or chromosomal aberrations were identified for any patients who had “atypical” results, and no significant differences in other perinatal outcomes were observed between Arab and non-Arab American patients. A better understanding of the association between consanguinity and “atypical” SNP-based NIPS results would aid in appropriate test selection and interpretation and may help physicians and genetic counselors provide better perinatal counseling and follow-up care for patients in consanguineous relationships.

PMID:37066630 | DOI:10.1002/jgc4.1714

Epidemiol Psychiatr Sci. 2023 Apr 17;32:e19. doi: 10.1017/S2045796023000136.

ABSTRACT

AIMS: Our study aimed to (1) identify trajectories on different mental health components during a two-year follow-up of the COVID-19 pandemic and contextualise them according to pandemic periods; (2) investigate the associations between mental health trajectories and several exposures, and determine whether there were differences among the different mental health outcomes regarding these associations.

METHODS: We included 5535 healthy individuals, aged 40-65 years old, from the Barcelona Brain Health Initiative (BBHI). Growth mixture models (GMM) were fitted to classify individuals into different trajectories for three mental health-related outcomes (psychological distress, personal growth and loneliness). Moreover, we fitted a multinomial regression model for each outcome considering class membership as the independent variable to assess the association with the predictors.

RESULTS: For the outcomes studied we identified three latent trajectories, differentiating two major trends, a large proportion of participants was classified into ‘resilient’ trajectories, and a smaller proportion into ‘chronic-worsening’ trajectories. For the former, we observed a lower susceptibility to the changes, whereas, for the latter, we noticed greater heterogeneity and susceptibility to different periods of the pandemic. From the multinomial regression models, we found global and cognitive health, and coping strategies as common protective factors among the studied mental health components. Nevertheless, some differences were found regarding the risk factors. Living alone was only significant for those classified into ‘chronic’ trajectories of loneliness, but not for the other outcomes. Similarly, secondary or higher education was only a risk factor for the ‘worsening’ trajectory of personal growth. Finally, smoking and sleeping problems were risk factors which were associated with the ‘chronic’ trajectory of psychological distress.

CONCLUSIONS: Our results support heterogeneity in reactions to the pandemic and the need to study different mental health-related components over a longer follow-up period, as each one evolves differently depending on the pandemic period. In addition, the understanding of modifiable protective and risk factors associated with these trajectories would allow the characterisation of these segments of the population to create targeted interventions.

PMID:37066626 | DOI:10.1017/S2045796023000136

Health Informatics J. 2023 Apr-Jun;29(2):14604582231170892. doi: 10.1177/14604582231170892.

ABSTRACT

The Integrated Clinical and Environmental Exposures Service (ICEES) provides open regulatory-compliant access to clinical data, including electronic health record data, that have been integrated with environmental exposures data. While ICEES has been validated in the context of an asthma use case and several other use cases, the regulatory constraints on the ICEES open application programming interface (OpenAPI) result in data loss when using the service for multivariate analysis. In this study, we investigated the robustness of the ICEES OpenAPI through a comparative analysis, in which we applied a generalized linear model (GLM) to the OpenAPI data and the constraint-free source data to examine factors predictive of asthma exacerbations. Consistent with previous studies, we found that the main predictors identified by both analyses were sex, prednisone, race, obesity, and airborne particulate exposure. Comparison of GLM model fit revealed that data loss impacts model quality, but only with select interaction terms. We conclude that the ICEES OpenAPI supports multivariate analysis, albeit with potential data loss that users should be aware of.

PMID:37066514 | DOI:10.1177/14604582231170892

Eur J Heart Fail. 2023 Apr 16. doi: 10.1002/ejhf.2857. Online ahead of print.

ABSTRACT

BACKGROUND: In the EMPEROR-Preserved trial, empagliflozin improved clinical outcomes of patients with heart failure with preserved ejection fraction. In this pre-specified analysis, we aim to study the effect of empagliflozin on cardiovascular and kidney outcomes across the spectrum of kidney function.

METHODS: Patients were categorized by the presence or absence of chronic kidney disease (CKD) at baseline (CKD defined by an estimated glomerular filtration rate [eGFR] <60ml/min/1.73m² or urine albumin to creatinine ratio [UACR]>300mg/g). The primary and key secondary outcomes were (1) a composite of cardiovascular death or first HF hospitalization (primary outcome); (2) total number of HF hospitalization, (3) eGFR slope; and a prespecified exploratory composite kidney outcome including a sustained ≥ 40% decline in eGFR, chronic dialysis or renal transplant. The median follow-up was 26.2 months.

RESULTS: 5,988 patients were randomized to empagliflozin or placebo, of whom 3,198 (53.5%) had CKD. Irrespective of CKD status, empagliflozin reduced the primary outcome (with CKD HR 0.80 [95% CI 0.69, 0.94], and without CKD HR 0.75 [95% CI 0.60 0.95], interaction P=0.67) and total (first and recurrent) hospitalizations for HF (with CKD 0.68, [95% CI 0.54, 0.86], and without CKD 0.89 [95% CI 0.66, 1.21], interaction P=0.17). Empagliflozin slowed the slope of eGFR decline by 1.43 (1.01, 1.85) ml/min/1.73m² /year in patients with CKD and 1.31 (0.88, 1.74) ml/min/1.73m² /year without CKD (interaction P=0.70). Empagliflozin did not reduce the pre-specified kidney outcome in patients with or without CKD (with CKD HR 0.97 [95% CI 0.71,1.34]; without CKD HR 0.92 [0.58, 1.48], interaction P=0.86) but slowed progression to macroalbuminuria and reduced the risk of acute kidney injury. The effect of empagliflozin on the primary composite outcome and the key secondary outcomes was consistent across 5 baseline eGFR categories (all interaction p-value > 0.05). Empagliflozin was well tolerated independent of CKD status.

CONCLUSIONS: In EMPEROR-Preserved, empagliflozin had a beneficial effect on the key efficacy outcomes in patients with and without CKD. Overall, the benefit and safety of empagliflozin was consistent across a wide range of kidney function spectrum, down to a baseline eGFR of 20 ml/min/1.73m² .

PMID:37062851 | DOI:10.1002/ejhf.2857

BMC Palliat Care. 2023 Apr 17;22(1):43. doi: 10.1186/s12904-023-01168-7.

ABSTRACT

BACKGROUND: Advance care planning (ACP) is the process supporting individuals with life-limiting illness to make informed decisions about their future healthcare. Ethnic disparities in ACP have been widely highlighted, but interpretation is challenging due to methodological heterogeneity. This review aims to examine differences in the presence of documented ACP in individuals’ care records for people with advanced disease by ethnic group, and identify patient and clinician related factors contributing to this.

METHODS: Mixed-methods systematic review. Keyword searches on six electronic databases were conducted (01/2000-04/2022). The primary outcome measure was statistically significant differences in the presence of ACP in patients’ care records by ethnicity: quantitative data was summarised and tabulated. The secondary outcome measures were patient and clinician-based factors affecting ACP. Data was analysed qualitatively through thematic analysis; themes were developed and presented in a narrative synthesis. Feedback on themes was gained from Patient and Public Involvement (PPI) representatives. Study quality was assessed through Joanna Briggs Institute Critical Appraisal tools and Gough’s Weight of Evidence.

RESULTS: N=35 papers were included in total; all had Medium/High Weight of Evidence. Fifteen papers (comparing two or more ethnic groups) addressed the primary outcome measure. Twelve of the fifteen papers reported White patients had statistically higher rates of formally documented ACP in their care records than patients from other ethnic groups. There were no significant differences in the presence of informal ACP between ethnic groups. Nineteen papers addressed the secondary outcome measure; thirteen discussed patient-based factors impacting ACP presence with four key themes: poor awareness and understanding of ACP; financial constraints; faith and religion; and family involvement. Eight papers discussed clinician-based factors with three key themes: poor clinician confidence around cultural values and ideals; exacerbation of institutional constraints; and pre-conceived ideas of patients’ wishes.

CONCLUSIONS: This review found differences in the presence of legal ACP across ethnic groups despite similar presence of informal end of life conversations. Factors including low clinician confidence to deliver culturally sensitive, individualised conversations around ACP, and patients reasons for not wishing to engage in ACP (including, faith, religion or family preferences) may begin to explain some documented differences.

TRIAL REGISTRATION: PROSPERO-CRD42022315252.

PMID:37062841 | DOI:10.1186/s12904-023-01168-7