Tag: nevin manimala

JAMA Netw Open. 2022 Nov 1;5(11):e2239485. doi: 10.1001/jamanetworkopen.2022.39485.

ABSTRACT

IMPORTANCE: Alcohol consumption is a leading preventable cause of death in the US, and death rates from fully alcohol-attributable causes (eg, alcoholic liver disease) have increased in the past decade, including among adults aged 20 to 64 years. However, a comprehensive assessment of alcohol-attributable deaths among this population, including from partially alcohol-attributable causes, is lacking.

OBJECTIVE: To estimate the mean annual number of deaths from excessive alcohol use relative to total deaths among adults aged 20 to 64 years overall; by sex, age group, and state; and as a proportion of total deaths.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study of mean annual alcohol-attributable deaths among US residents between January 1, 2015, and December 31, 2019, used population-attributable fractions. Data were analyzed from January 6, 2021, to May 2, 2022.

EXPOSURES: Mean daily alcohol consumption among the 2 089 287 respondents to the 2015-2019 Behavioral Risk Factor Surveillance System was adjusted using national per capita alcohol sales to correct for underreporting. Adjusted mean daily alcohol consumption prevalence estimates were applied to relative risks to generate alcohol-attributable fractions for chronic partially alcohol-attributable conditions. Alcohol-attributable fractions based on blood alcohol concentrations were used to assess acute partially alcohol-attributable deaths.

MAIN OUTCOMES AND MEASURES: Alcohol-attributable deaths for 58 causes of death, as defined in the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application. Mortality data were from the National Vital Statistics System.

RESULTS: During the 2015-2019 study period, of 694 660 mean deaths per year among adults aged 20 to 64 years (men: 432 575 [66.3%]; women: 262 085 [37.7%]), an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption. This percentage was higher among men (15.0%) than women (9.4%). By state, alcohol-attributable deaths ranged from 9.3% of total deaths in Mississippi to 21.7% in New Mexico. Among adults aged 20 to 49 years, alcohol-attributable deaths (44 981 mean annual deaths) accounted for an estimated 20.3% of total deaths.

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that an estimated 1 in 8 total deaths among US adults aged 20 to 64 years were attributable to excessive alcohol use, including 1 in 5 deaths among adults aged 20 to 49 years. The number of premature deaths could be reduced with increased implementation of evidenced-based, population-level alcohol policies, such as increasing alcohol taxes or regulating alcohol outlet density.

PMID:36318209 | DOI:10.1001/jamanetworkopen.2022.39485

JAMA Netw Open. 2022 Nov 1;5(11):e2239491. doi: 10.1001/jamanetworkopen.2022.39491.

ABSTRACT

IMPORTANCE: During menopause, the levels of estrogen and progesterone decrease and 60% to 70% of women experience menopausal symptoms, including mood disturbances. The latter might be prevented by hormone therapy (HT), yet some studies have suggested that use of HT might be associated with increased risk of depression.

OBJECTIVE: To examine whether use of HT during menopause was associated with a subsequent diagnosis of depression.

DESIGN, SETTING, AND PARTICIPANTS: This nationwide register-based cohort and self-controlled case series study included all women in Denmark aged 45 years between January 1, 1995, through December 31, 2017 (n = 825 238), without prior oophorectomy, breast cancer, or cancer in reproductive organs. Follow-up was completed on December 31, 2018. The statistical analysis was performed from September 1, 2021, through May 31, 2022.

EXPOSURES: Redeemed prescriptions of different types of HT identified by the Anatomical Therapeutic Chemical classification system codes (G03C [estrogen] and G03F [estrogen combined with progestin]) in the Danish National Prescription Registry between 1995 and 2017. Type of administration was divided into systemic (oral or transdermal) and local (intravaginal or intrauterine).

MAIN OUTCOMES AND MEASURES: A hospital diagnosis of depression (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes F32-F33 and International Classification of Diseases, Eighth Revision, codes 296.09, 296.29, 298.0, and 300.49) between 1995 through 2018. Associations were examined in cohort and self-controlled case series analysis using Cox proportional hazards and fixed-effects Poisson regression models.

RESULTS: During follow-up from 45 years of age to a mean of 56.0 (range, 45.1-67.7) years, 189 821 women (23.0%) initiated systemically or locally administered HT and 13 069 (1.6%) were diagnosed with depression. Systemically administered HT was mainly initiated before 50 years of age and was associated with a higher risk of a subsequent depression diagnosis (hazard ratio [HR] for 48-50 years of age, 1.50 [95% CI, 1.24-1.81]). The risk was especially elevated the year after initiation of both treatment with estrogen alone (HR, 2.03 [95% CI, 1.21-3.41]) and estrogen combined with progestin (HR, 2.01 [95% CI,1.26-3.21]). Locally administered HT was initiated across all ages and was not associated with depression risk (HR, 1.15 [95% CI, 0.70-1.87]). It was, however, associated with a lower risk of depression when initiated after 54 years of age (HR for 54-60 years of age, 0.80 [95% CI, 0.70-0.91]). In self-controlled analysis, which efficiently accounts for time-invariant confounding, users of systemically administered HT had higher rates of depression in the years after initiation compared with the years before treatment (incidence rate ratio for 0-1 year after initiation, 1.66 [95% CI, 1.30-2.14]).

CONCLUSIONS AND RELEVANCE: These findings suggest that systemically administered HT before and during menopause is associated with higher risk of depression, especially in the years immediately after initiation, whereas locally administered HT is associated with lower risk of depression for women 54 years or older.

PMID:36318208 | DOI:10.1001/jamanetworkopen.2022.39491

JAMA Netw Open. 2022 Nov 1;5(11):e2239772. doi: 10.1001/jamanetworkopen.2022.39772.

ABSTRACT

IMPORTANCE: Cannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition.

OBJECTIVE: To evaluate the Single-Item Screen-Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD.

DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022.

EXPOSURES: The SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients’ medical records.

MAIN OUTCOMES AND MEASURES: The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population.

RESULTS: Of 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%.

CONCLUSIONS AND RELEVANCE: In this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

PMID:36318205 | DOI:10.1001/jamanetworkopen.2022.39772

J Vis. 2022 Nov 1;22(12):1. doi: 10.1167/jov.22.12.1.

ABSTRACT

Previous work has claimed that canonical viewpoints of objects are more readily perceived than noncanonical viewpoints. However, all of these studies required participants to identify the object, a late perceptual process at best and arguably a cognitive process (Pylyshyn, 1999). Here, we extend this work to early vision by removing the explicit need to identify the objects. In particular, we asked participants to make an intact/scrambled discrimination of briefly presented objects that were viewed from either typical or atypical viewpoints. Notably, participants did not have to identify the object; only discriminate it from noise (scrambled). Participants were more sensitive in discriminating objects presented in typically encountered orientations than when objects were presented in atypical depth rotations (Experiment 1). However, the same effect for objects presented in atypical picture plane rotations (as opposed to typical ones) did not reach statistical significance (Experiments 2 and 3), suggesting that particular informative views may play a critical role in this effect. We interpret this enhanced perceptibility, for both these items and good exemplars and probable scenes, as deriving from their high real-world statistical regularity.

PMID:36318192 | DOI:10.1167/jov.22.12.1

JAMA. 2022 Nov 1;328(17):1768-1770. doi: 10.1001/jama.2022.18865.

NO ABSTRACT

PMID:36318139 | DOI:10.1001/jama.2022.18865

JAMA. 2022 Nov 1;328(17):1747-1765. doi: 10.1001/jama.2022.18324.

ABSTRACT

IMPORTANCE: It is uncertain whether hormone therapy should be used for the primary prevention of chronic conditions such as heart disease, osteoporosis, or some types of cancers.

OBJECTIVE: To update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions.

DATA SOURCES: PubMed/MEDLINE, Cochrane Library, EMBASE, and trial registries from January 1, 2016, through October 12, 2021; surveillance through July 2022.

STUDY SELECTION: English-language randomized clinical trials and prospective cohort studies of fair or good quality.

DATA EXTRACTION AND SYNTHESIS: Dual review of abstracts, full-text articles, and study quality; meta-analyses when at least 3 similar studies were available.

MAIN OUTCOMES AND MEASURES: Morbidity and mortality related to chronic conditions; health-related quality of life.

RESULTS: Twenty trials (N = 39 145) and 3 cohort studies (N = 1 155 410) were included. Participants using estrogen only compared with placebo had significantly lower risks for diabetes over 7.1 years (1050 vs 903 cases; 134 fewer [95% CI, 18-237]) and fractures over 7.2 years (1024 vs 1413 cases; 388 fewer [95% CI, 277-489]) per 10 000 persons. Risks per 10 000 persons were statistically significantly increased for gallbladder disease over 7.1 years (1113 vs 737 cases; 377 more [95% CI, 234-540]), stroke over 7.2 years (318 vs 239 cases; 79 more [95% CI, 15-159]), venous thromboembolism over 7.2 years (258 vs 181 cases; 77 more [95% CI, 19-153]), and urinary incontinence over 1 year (2331 vs 1446 cases; 885 more [95% CI, 659-1135]). Participants using estrogen plus progestin compared with placebo experienced significantly lower risks, per 10 000 persons, for colorectal cancer over 5.6 years (59 vs 93 cases; 34 fewer [95% CI, 9-51]), diabetes over 5.6 years (403 vs 482 cases; 78 fewer [95% CI, 15-133]), and fractures over 5 years (864 vs 1094 cases; 230 fewer [95% CI, 66-372]). Risks, per 10 000 persons, were significantly increased for invasive breast cancer (242 vs 191 cases; 51 more [95% CI, 6-106]), gallbladder disease (723 vs 463 cases; 260 more [95% CI, 169-364]), stroke (187 vs 135 cases; 52 more [95% CI, 12-104]), and venous thromboembolism (246 vs 126 cases; 120 more [95% CI, 68-185]) over 5.6 years; probable dementia (179 vs 91 cases; 88 more [95% CI, 15-212]) over 4.0 years; and urinary incontinence (1707 vs 1145 cases; 562 more [95% CI, 412-726]) over 1 year.

CONCLUSIONS AND RELEVANCE: Use of hormone therapy in postmenopausal persons for the primary prevention of chronic conditions was associated with some benefits but also with an increased risk of harms.

PMID:36318128 | DOI:10.1001/jama.2022.18324

Biol Open. 2022 Oct 31:bio.059229. doi: 10.1242/bio.059229. Online ahead of print.

ABSTRACT

Plasticity in hatching time allows embryos to maximize fitness by balancing benefits and costs of remaining bound within the chorion against the benefits and costs of emerging as a free-swimming larva. In our first experiment, we exposed zebrafish (Danio rerio) embryos to either chemical cues from crushed embryos (simulating egg predation) or to blank water control. Embryos exposed to alarm cues hatched sooner with shorter body lengths and underdeveloped fins relative to larvae from the water treatment. Burst swimming speed was significantly slower for larvae that hatched from the alarm cue treatment. In a second 2 x 2 experiment, we exposed zebrafish embryos to either chemical alarm cues from conspecific embryos, mechanical disturbance (magnetic stir bar) to simulate a predator probing the substrate for developing embryos, both chemical and mechanical indicators of risk, or neither (control). We found similar effects in terms of earlier time to hatch at an earlier stage of development and poorer swimming performance of hatchling larvae. In the second experiment these effects occurred in response to mechanical disturbance with or without the presence of chemical alarm cues. Alarm cues alone produced no effects in the second experiment. Taken together, these data indicate that zebrafish embryos demonstrate a facultative tradeoff between risk of predation acting on two stages of their life history.

PMID:36318109 | DOI:10.1242/bio.059229

Radiology. 2022 Nov 1:212922. doi: 10.1148/radiol.212922. Online ahead of print.

ABSTRACT

Background Deep learning (DL)-based MRI reconstructions can reduce examination times for turbo spin-echo (TSE) acquisitions. Studies that prospectively employ DL-based reconstructions of rapidly acquired, undersampled spine MRI are needed. Purpose To investigate the diagnostic interchangeability of an unrolled DL-reconstructed TSE (hereafter, TSE_DL) T1- and T2-weighted acquisition method with standard TSE and to test their impact on acquisition time, image quality, and diagnostic confidence. Materials and Methods This prospective single-center study included participants with various spinal abnormalities who gave written consent from November 2020 to July 2021. Each participant underwent two MRI examinations: standard fully sampled T1- and T2-weighted TSE acquisitions (reference standard) and prospectively undersampled TSE_DL acquisitions with threefold and fourfold acceleration. Image evaluation was performed by five readers. Interchangeability analysis and an image quality-based analysis were used to compare the TSE and TSE_DL images. Acquisition time and diagnostic confidence were also compared. Interchangeability was tested using the individual equivalence index regarding various degenerative and nondegenerative entities, which were analyzed on each vertebra and defined as discordant clinical judgments of less than 5%. Interreader and intrareader agreement and concordance (κ and Kendall τ and W statistics) were computed and Wilcoxon and McNemar tests were used. Results Overall, 50 participants were evaluated (mean age, 46 years ± 18 [SD]; 26 men). The TSE_DL method enabled up to a 70% reduction in total acquisition time (100 seconds for TSE_DL vs 328 seconds for TSE, P < .001). All individual equivalence indexes were less than 4%. TSE_DL acquisition was rated as having superior image noise by all readers (P < .001). No evidence of a difference was found between standard TSE and TSE_DL regarding frequency of major findings, overall image quality, or diagnostic confidence. Conclusion The deep learning (DL)-reconstructed turbo spin-echo (TSE) method was found to be interchangeable with standard TSE for detecting various abnormalities of the spine at MRI. DL-reconstructed TSE acquisition provided excellent image quality, with a 70% reduction in examination time. German Clinical Trials Register no. DRKS00023278 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Hallinan in this issue.

PMID:36318032 | DOI:10.1148/radiol.212922

Acta Med Acad. 2022 Aug;51(2):85-91. doi: 10.5644/ama2006-124.376.

ABSTRACT

OBJECTIVES: Superficial benign parotid tumors are a common neoplasm of the salivary glands. Different surgical procedures have been applied for partial superficial parotidectomy (PSP) and extracapsular dissection (ECD), which are the two predominant surgical techniques. Our study aimed to evaluate PSP versus ECD for benign parotid tumors, in relation to post-operative complications and recurrence rates.

MATERIALS AND METHODS: 266 patients who underwent parotidectomies of benign superficial parotid tumors were evaluated retrospectively. The first group (PSP group) was composed of 143 patients who underwent PSP, and the second group (ECD group) was composed of 123 patients who underwent ECD.

RESULTS: In the ECD group the rate of patients presenting with total postoperative permanent facial nerve paralysis, House-Brackmann grade III, was 0.8%, whereas in the PSP group it was 1.4%. Frey’s syndrome was only reported in the PSP group. Salivary fistula occurred in both groups at similar rates. Sensation dysfunction due to greater auricular nerve division occurred in 72% patients in the PSP group and 10.6% in the ECD group. No statistical difference regarding recurrence rates was found between the two groups.

CONCLUSIONS: Both ECD and PSP procedures are safe surgical options for superficial parotidectomy in the treatment of benign tumors, with similar recurrence rates and post-surgical complications, apart from sensation abnormalities due to more extensive auricular nerve division.

PMID:36318000 | DOI:10.5644/ama2006-124.376

Br J Math Stat Psychol. 2022 Nov 1. doi: 10.1111/bmsp.12290. Online ahead of print.

ABSTRACT

Response process data collected from human-computer interactive items contain detailed information about respondents’ behavioural patterns and cognitive processes. Such data are valuable sources for analysing respondents’ problem-solving strategies. However, the irregular data format and the complex structure make standard statistical tools difficult to apply. This article develops a computationally efficient method for exploratory analysis of such process data. The new approach segments a lengthy individual process into a sequence of short subprocesses to achieve complexity reduction, easy clustering and meaningful interpretation. Each subprocess is considered a subtask. The segmentation is based on sequential action predictability using a parsimonious predictive model combined with the Shannon entropy. Simulation studies are conducted to assess the performance of the new method. We use a case study of PIAAC 2012 to demonstrate how exploratory analysis for process data can be carried out with the new approach.

PMID:36317951 | DOI:10.1111/bmsp.12290