Tag: nevin manimala

Diabetes Technol Ther. 2025 Jan 6. doi: 10.1089/dia.2024.0472. Online ahead of print.

ABSTRACT

Objective: The recommended threshold for the time spent on continuous glucose monitoring (CGM) is established at 70%. However, glucose outcomes in children with type 1 diabetes (CwD) using CGM for a different proportion of time within this threshold have not been evaluated yet. The study aims to compare glycemic parameters among CwD who spent 70%-89% and ≥90% on CGM using the population-wide data from the Czech national pediatric diabetes registry ČENDA. Methods: CwD aged <19 years who used real-time CGM >70% of the time and did not change the type of therapy throughout the year 2023 were included and divided into two groups based on the time they spent on CGM-70%-89% versus ≥90%. HbA1c, times in standard glycemic ranges, mean glucose, and coefficient of variability (CV) were compared between the groups and by treatment modalities. Results: Data from 1977 CwD (1035 males and 942 females) were evaluated. Among them, 404 participants (20.4%) used CGM 70%-89% of the time, and 1573 participants (79.6%) ≥90% of the time. Compared with the 70-89% group, the ≥90% CGM users achieved significantly lower HbA1c levels (51 mmol/mol, 6.8% vs. 58 mmol/mol, 7.4%, P < 0.001), higher time in range (72% vs. 60%, P < 0.001), and lower mean glucose and CV (8.1 mmol/L, 146 mg/dL vs. 9.1 mmol/L, 164 mg/dL and 37% vs. 40%, respectively, both P < 0.001). Analogous results were seen irrespective of the treatment modality. The differences persisted after propensity score adjustment. Conclusion: CGM use for ≥90% is associated with tighter glycemic control compared with 70%-89% use. Therefore, it is essential to motivate CwD to use CGM for the longest possible time and search for suitable options to overcome barriers in uninterrupted CGM monitoring.

PMID:39761072 | DOI:10.1089/dia.2024.0472

JAMA Netw Open. 2025 Jan 2;8(1):e2452883. doi: 10.1001/jamanetworkopen.2024.52883.

ABSTRACT

IMPORTANCE: Intraventricular hemorrhage (IVH) has proven to be a challenging and enduring complication of prematurity. However, its association with neurodevelopment across the spectrum of IVH severity, independent of prematurity, and in the context of contemporary care remains uncertain.

OBJECTIVE: To evaluate national trends in IVH diagnosis and the association with survival and neurodevelopmental outcomes at 2 years of age.

DESIGN, SETTING, AND PARTICIPANTS: This whole-population cohort study was conducted using data from the UK National Neonatal Research Database. Infants born at less than 29 weeks’ gestation with any grade of IVH between January 2013 and December 2019 in England were included and matched with controls. Data analysis occurred from November 2023 to June 2024.

EXPOSURE: IVH grades 1 to 4 (Papile classification).

MAIN OUTCOMES AND MEASURES: The primary outcome was survival without severe neurodevelopmental impairment (NDI) at 2 years’ corrected age including severe delays (inability to understand or use >5 words or signs; being unable to walk, sit, or use hands; blindness; or uncorrectable hearing impairment). Secondary outcomes included gross and fine motor function, receptive and expressive communication, vision, hearing, and overall developmental progress. Outcomes were derived from clinician-entered data and analyzed using multiple logistic regression.

RESULTS: Between 2013 and 2019, of 26 756 infants born at less 29 weeks’ gestation in England, 8461 received a diagnosis of IVH (5570 low-grade and 2891 high-grade, and 8328 were included in the study. Overall, 5519 included infants had low-grade IVH with a median [IQR] gestational age of 26 (25-27) weeks, of which 2477 (48.88%) were male. Of the 2809 included infants with high-grade IVH, the median (IQR) gestational age was 25 (24-26) weeks and 1710 (60.88%) were male. The mean (SD) incidence of high-grade IVH (108 [6.7] per 1000 live extremely preterm births) and low-grade IVH (208 [10.4] per 1000 live extremely preterm births) increased between 2013 and 2019, although this did not reach statistical significance for high-grade IVH. Survival without severe NDI decreased significantly after high-grade IVH (a 74% reduction; aOR, 0.26; 95% CI, 0.22-0.31), and to a lesser extent after low-grade IVH (a 12% reduction; aOR, 0.88; 95% CI, 0.79-0.98). Although low-grade IVH was associated with functional impairments, most survivors, 2283 of 4379 infants (52.15%), had no NDI, and the association with NDI was accounted for by grade 2 IVH. Decreased survival without severe NDI was observed with increasing grade of IVH, decreasing gestation, bilateral compared to unilateral injuries, and increasing morbidity count (severe retinopathy of prematurity, bronchopulmonary dysplasia, and surgical necrotizing enterocolitis). Impairments in gross motor function and communication were common, especially among those with high-grade IVH (with prevalences of 44.55% [715 of 1605 infants] and 48.91% [784 of 1603 infants], respectively).

CONCLUSIONS AND RELEVANCE: In this cohort study, IVH was highlighted as a persistent issue with substantial neurodevelopmental implications despite advances in care. This study offers useful data for counseling families; however, follow-up to school age is necessary to grasp the full impact of these injuries on children’s lives.

PMID:39761048 | DOI:10.1001/jamanetworkopen.2024.52883

JAMA Netw Open. 2025 Jan 2;8(1):e2453292. doi: 10.1001/jamanetworkopen.2024.53292.

ABSTRACT

IMPORTANCE: Characterizing hospital-level factors associated with adverse outcomes following operative vaginal delivery (OVD) is crucial for optimizing obstetric care.

OBJECTIVE: To assess the association between hospital OVD volume and adverse outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study of OVDs in California between 2008 and 2020. OVD was determined using birth certificate and International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. This study used linked vital statistics and hospital discharge data from California. The study included singleton, nonanomalous, full-term deliveries with vertex presentation. Data analysis was performed between June 10 and October 23, 2024.

EXPOSURE: Hospital OVD volume was categorized by the proportion of OVDs performed among all deliveries, grouped into low (<5.2%), medium (5.2%-7.4%), and high (≥7.4%) volume.

MAIN OUTCOMES AND MEASURES: Adverse outcomes for birthing individuals included obstetric anal sphincter injuries, cervical lacerations, and postpartum hemorrhage. Neonatal outcomes included shoulder dystocia, subgaleal hemorrhage, intracranial hemorrhage, facial nerve injury, and brachial plexus injury (BPI). χ2 and multivariable Poisson regression analyses were used to assess the association between hospital OVD volume and outcomes.

RESULTS: Among 306 818 OVDs (mean [SD] birthing parent’s age, 28.5 [6.2] years; 155 157 patients with public insurance [50.6%]), hospitals with low OVD volume had an increased proportion of obstetric anal sphincter injury compared with hospitals with medium and high volumes (12.16% [7444 patients] vs 11.07% [10 709 patients] vs 9.45% [14 064 patients]). Hospitals with low volume also had a higher proportion of adverse neonatal outcomes, including shoulder dystocia (3.84% [2351 patients] vs 3.50% [3386 patients] vs 2.80% [4160 patients]), subgaleal hemorrhage (0.27% [165 patients] vs 0.18% [172 patients] vs 0.10% [144 patients]), and BPI (0.41% [251 patients] vs 0.30% [291 patients] vs 0.20% [301 patients]) compared with hospitals with medium and high volume. In multivariable analyses, low OVD volume remained associated with increased risk of obstetric anal sphincter injury (adjusted risk ratio [aRR], 1.36; 95% CI, 1.14-1.62), shoulder dystocia (aRR, 1.30; 95% CI, 1.10-1.52), subgaleal hemorrhage (aRR, 2.57; 95% CI, 1.55-4.24), and BPI (aRR, 1.73; 95% CI, 1.30-2.2.29) compared with hospitals with high OVD volume. After multivariable analysis, medium OVD volume remained associated with increased risk of subgaleal hemorrhage (aRR, 1.72; 95% CI, 1.04-2.86) and BPI (aRR, 1.35; 95% CI, 1.02-1.79) compared with high OVD volume.

CONCLUSIONS AND RELEVANCE: This study found that undergoing OVD at hospitals with low OVD volume was associated with adverse perinatal outcomes compared with hospitals with medium and high OVD volumes. Further exploration of the reasons for these differences and prevention of these differences is needed to improve obstetric outcomes.

PMID:39761043 | DOI:10.1001/jamanetworkopen.2024.53292

J Neurotrauma. 2025 Jan 6. doi: 10.1089/neu.2024.0117. Online ahead of print.

ABSTRACT

Traumatic brain injury (TBI) and subsequent post-traumatic epilepsy (PTE) often impair daily activities and mental health (MH), which contribute to long-term TBI-related disability. PTE also affects driving capacity, which impacts functional independence, community participation, and satisfaction with life (SWL). However, studies evaluating the collective impact of PTE on multidimensional outcomes are lacking. Thus, we generated a model to investigate how PTE after moderate-to-severe (ms)TBI affects TBI-associated impairments, limits activities and participation, and influences SWL. Of 5108 participants with msTBI enrolled into the National Institute for Disability, Independent Living, and Rehabilitation Research TBI Model Systems between 2010 and 2018 and with seizure-event data available at year-1 post-TBI, 1214 had complete outcome data and 1003 had complete covariate data used for analysis. We constructed a conceptual framework illustrating hypothesized interrelationships between year-1 PTE, driving status, functional independence measure (FIM), depression and anxiety, as well as year-2 participation, and SWL. We performed univariate and multivariable linear and logistic regressions. A covariate-adjusted structural equation model (SEM), using the lavaan package (R), assessed the conceptual framework’s suitability in establishing PTE links with outcomes 1-2 years post-injury. Multiple parameters were evaluated to assess SEM fit. Year-1 PTE was correlated with year-1 FIM motor (standardized coefficient, β_std = -0.112, p = 0.007) and showed a trend level association with year-1 FIM cognition (β_std = -0.070, p = 0.079). Individuals with year-1 PTE were less likely to drive independently at year 1 (β_std = -0.148, p < 0.001). In addition, FIM motor (β_std = 0.323, p < 0.001), FIM cognition (β_std = 0.181, p = 0.012), and anxiety (β_std = -0.135, p = 0.024) influenced driving status. FIM cognition was associated with year-1 depression (β_std = 0.386, p < 0.001) and year-1 anxiety (β_std = 0.396, p < 0.001), whereas year-1 FIM motor (β_std = 0.186, p = 0.003), depression (β_std = -0.322, p = 0.011), and driving status (β_std = 0.233, p < 0.001) directly affected year-2 objective life participation metrics. Moreover, year-1 depression (β_std = -0.382, p = 0.001) and year-2 participation (β_std = 0.160, p < 0.001) had direct effects on year-2 SWL. SWL was influenced indirectly by year-1 variables, including functional impairment, anxiety, and driving status-factors that impacted year-2 participation directly or indirectly, and consequently year-2 SWL, forming a complex relationship with year-1 PTE. A sensitivity analysis SEM showed that the number of MH disorders was associated with participation and SWL (p < 0.001), and this combined MH variable was directly related to driving status (p < 0.02). Developing PTE during year-1 after msTBI affects multiple aspects of life. PTE effects extend to motor and cognitive abilities, driving capabilities, and indirectly, to life participation and overall SWL. The implications underscore the crucial need for effective PTE management strategies during the first year post-TBI to minimize the adverse impact on factors influencing multidimensional year-2 participation and SWL outcomes. Addressing transportation barriers is warranted to enhance the well-being of those with PTE and msTBI, emphasizing a holistic approach. Further research is recommended for SEM validation studies, including testing causal inference pathways that might inform future prevention and treatment trials.

PMID:39761035 | DOI:10.1089/neu.2024.0117

Child Obes. 2025 Jan 6. doi: 10.1089/chi.2024.0374. Online ahead of print.

ABSTRACT

It is unknown if children and youth who live in rural or “less rural” locations who enroll in the provincially funded Generation Health Clinic (British Columbia, Canada), a family-based lifestyle program for weight management, present with different health behaviors at baseline. Thus, we assessed sociodemographic and health behavior (diet, physical activity, and sleep) collected between 2015 and 2019. Data were stratified by age (children: ≤12 years; adolescents: ≥13 years) and geographical location (“less urban” and urban) based on Statistics Canada definitions and then analyzed using independent t-tests and chi–square tests. We found that more “urban” children consumed more daily family meals (p < 0.001), ate out weekly (p = 0.02), ate “other” vegetables (p = 0.002), and had less frequent sports drink consumption (p < 0.001) compared with less urban children. No significant differences in health behaviors were seen in adolescents. These findings suggest that a participant’s geographical location should be considered when developing family-based interventions for weight management.

PMID:39761009 | DOI:10.1089/chi.2024.0374

Disabil Rehabil. 2025 Jan 6:1-11. doi: 10.1080/09638288.2024.2449399. Online ahead of print.

ABSTRACT

AIM: Family-centred service aims to build family capacity to support their children, but behaviours supporting capacity-building vary. We explored what influences the way service providers think about and approach family-centred service.

METHOD: An online survey drew on experiences, beliefs, and perspectives of Australian providers. Descriptive statistics were applied to quantitative data and inductive content analysis to qualitative, with a comparative discussion to merge data.

RESULTS: The 73 participating medical and allied health professionals reflected family-centred service as a way of “knowing”, “being”, and “doing”. There were no observed differences in beliefs, perceptions, or behaviours between those with different professional training, experience, or work contexts. Participants described Collaborative partnerships as a way of working together with families. Work was influenced by (1) Who I am, (2) How I perceive influences beyond me, and that (3) Overlapping values and priorities supports sustained motivation.

INTERPRETATION: Findings indicated that providers “way of knowing” influenced their “way of doing”. Education is needed to align providers understanding of family-centred service with contemporary evidence. Strategies tailored to each context are required to support providers to balance competing priorities for themselves, families they work with, and surrounding services and systems, and sustain and promote family-centred service in practice.

PMID:39761007 | DOI:10.1080/09638288.2024.2449399

J Urban Health. 2025 Jan 6. doi: 10.1007/s11524-024-00949-6. Online ahead of print.

ABSTRACT

Neighborhoods or residential environments have physical and social attributes which may contribute to inequalities in the overweight and obesity pandemic. We examined the longitudinal associations of baseline neighborhood-level income and racial residential segregation (using the Gi* statistic: low, medium, high) with changes in body mass index (BMI in kg/m²), using geocoded data from 1821 civil servants in the municipality of Rio de Janeiro, Brazil, followed-up for approximately 13 years (baseline wave 1: 1999, wave 2: 2001-2002, wave 3: 2006-2007, wave 4: 2012-2013). Linear mixed effects models using BMI measured in all four study waves were performed, accounting for gender, race, length of residence, education and time-dependent age, and per capita family income. After adjustments, both income and racial segregation were positively associated with BMI differences (but not BMI changes) over time, in a dose-response pattern. For income segregation, mean differences in BMI for participants living in high and medium vs. low segregated neighborhoods were 1.04 kg/m² (β = 1.04; 95% CI 0.47, 1.62) and 0.86 kg/m² (0.86; 0.33, 1.39), respectively. For racial segregation, mean differences in BMI for participants living in high and medium vs low segregated neighborhoods were 0.71 kg/m² (0.71; 0.14, 1.29) and 0.30 kg/m² (0.30; – 0.24, 0.83), respectively. We also showed a moderate to strong correlation between racial and income segregation at baseline. Strategies to reduce BMI and obesity-related health inequalities should include special efforts aimed at segregated neighborhoods and its obesogenic environments.

PMID:39760992 | DOI:10.1007/s11524-024-00949-6

J Cancer Surviv. 2025 Jan 6. doi: 10.1007/s11764-024-01726-9. Online ahead of print.

ABSTRACT

PURPOSE: Patients with rare cancer often experience diagnostic delays and limited treatment options, potentially negatively impacting their working lives. We explored whether those with rare vs. common cancer have an increased risk of loss of contractual employment (1) up to 2 years pre-diagnosis, (2) up to 5 years post-diagnosis, and (3) which characteristics of rare cancer survivors are associated with loss of contractual employment 5 years post-diagnosis.

METHODS: Data from the Netherlands Cancer Registry and Statistics Netherlands were linked. Demographic, work-related, and cancer-related characteristics were obtained of 16,203 patients with rare cancer and 23,295 unmatched patients with common breast or colorectal cancer. Transitions in primary source of income were explored from contractual employment to work disability, unemployment, social welfare, (early) retirement, or self-employment. Logistic regression and competing risk survival analyses were applied.

RESULTS: Employees with rare vs. common cancer had increased odds of becoming work-disabled pre-diagnosis (OR = 1.83, 95%CI 1.30-2.58) and of becoming self-employed post-diagnosis (HR = 1.32, 95%CI 1.03-1.68). Younger age and having a temporary employment contract were associated with becoming self-employed among those with rare cancers.

CONCLUSIONS: Employees with rare vs. common cancer have an increased risk of loss of contractual employment pre- and post-diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS: To reduce the risk of adverse work outcomes pre- and post-diagnosis, awareness and knowledge of rare cancers need to be increased to shorten time to diagnosis and accelerate access to adequate care.

PMID:39760980 | DOI:10.1007/s11764-024-01726-9

Int J Implant Dent. 2025 Jan 6;11(1):2. doi: 10.1186/s40729-024-00579-2.

ABSTRACT

PURPOSE: In this randomized clinical trial, we examined the incorporation of nanogold particles into polymethyl methacrylate denture bases and compared these modified bases with conventional ones in mandibular implant-retained overdentures, focusing on microbiological growth and adhesion characteristics.

METHODS: In this study, twenty-two male patients who were completely edentulous participated in a rehabilitation program involving mandibular overdentures retained by two dental implants placed in the canine area. The subjects were categorized into two equal groups, each comprising eleven patients. Group I received mandibular overdentures fabricated from conventional acrylic denture bases, whereas Group II received mandibular overdentures with bases that had undergone nanogold treatment. Microbial growth and colonization were evaluated around the implant’s necks and the fitting surface of each patient’s mandibular dentures. Three types of bacteria were studied: Candida albicans, Escherichia coli, and Streptococcus mutans. The mean difference in the counts of bacteria before the denture was inserted and after two, four, and six months has been calculated and analyzed statistically.

RESULTS: Regarding colony count (log 10 CFUs/mmL), there was a significant difference between the research groups. Group II had significantly lower values measured at 2, 4, and 6 months for Candida albicans, Escherichia coli, and Streptococcus mutans, respectively, than group I.

CONCLUSION: The addition of gold nanoparticles to PMMA denture bases was of greater benefit in inhibiting microbial growth than conventional acrylic resin bases.

PMID:39760976 | DOI:10.1186/s40729-024-00579-2

Intern Emerg Med. 2025 Jan 6. doi: 10.1007/s11739-024-03847-6. Online ahead of print.

ABSTRACT

Recent data on methods used by adults to stop smoking can inform tobacco control policies. Nationally representative Centers for Disease Control and Prevention survey data from the 2022 National Health Interview Survey (N = 27,651) were used to analyze populations of US adults who self-reported having stopped smoking cigarettes for 6 months or longer in the last year and the methods they used, or who did not stop smoking but tried in the last year (N = 1735). In 2022, an estimated 2.9 million [95% CI 2.5 million-3.2 million] US adults had stopped smoking in the past year. Most were male, non-Hispanic White, aged < 55 years, college-educated, identified as straight, were not depressed, and currently drank alcohol. The most popular methods used to stop smoking were nicotine products (53.9% [47.4-60.3%]; 1.5 [1.3-1.8] million adults), especially e-cigarettes in combination with other methods (40.8% [34.4-47.5%]; 1.2 [0.9-1.4] million) and e-cigarettes alone (26.0% [20.4-32.3%]; 0.7 [0.6-0.9] million). Prescription drug products (8.1% [5.3-11.8%]; 0.2 [0.1-0.3] million) and non-nicotine, non-prescription drug methods (6.3% (3.9-9.7%); 0.2 [0.1-0.3] million) were less popular. A further 13.1 [12.2-14.0] million tried but did not stop smoking. Compared to those who tried but didn’t stop smoking, those who successfully stopped were more likely to be younger, degree-educated, and to use e-cigarettes to stop smoking. Many adults still attempt to stop smoking unaided. Interventions to reduce smoking could focus on populations that stopped smoking the least and encourage use of evidence-based methods.

PMID:39760947 | DOI:10.1007/s11739-024-03847-6