Tag: pubmed

Recenti Prog Med. 2025 Feb;116(2):108-117. doi: 10.1701/4450.44442.

ABSTRACT

PURPOSE: Pulmonary embolism (PE) can compromise gases exchanges of patients admitted to respiratory wards. The objectives of this observational study were to identify radiological and arterial blood gases (ABG) differences in PEs documented by computed tomography pulmonary angiogram (CTPA) in Covid-19 pneumonia (C-19) vs cancer patients (CP).

METHODS: Fifty-one patients diagnosed with PE were evaluated, 18 CP and 33 C-19. Clinical, ABG and radiological parameters were evaluated. Jamovi software was used for statistics.

RESULTS: Wells score and D-dimer were both significantly higher in CP compared to C-19 cohort. DVT prevalence was significantly higher in CP patients. Alveolar-arterial O2 gradient (ΔA-aO2) was significantly higher in C-19 compared to CP cohort. PE associated to Covid-19 pneumonia was often bilateral and required a higher need of respiratory supports as High flow nasal cannula (HFNC), Continuous positive airway pressure (CPAP) and Non-invasive ventilation (NIV). In both cohorts, standard PaO2 and standard P/F were significantly lower than PaO2 and P/F. Multivariable linear regression analysis showed that in C-19 cohort PESI score and A-aO2 were independently and positively associated with PE severity.

DISCUSSION: These findings show that Wells score and D-dimer may underestimate PE’s risk in C-19 patients. P/F may underestimate the severity of respiratory failure compared to standard P/F. A-aO2 may be a useful tool for prediction of PE severity.

PMID:39931881 | DOI:10.1701/4450.44442

BJOG. 2025 Feb 11. doi: 10.1111/1471-0528.18092. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the 12-year effectiveness of pelvic floor muscle training versus midurethral sling surgery for moderate to severe female stress urinary incontinence.

DESIGN: Observational follow-up study of a randomised controlled trial.

SETTING: Conducted at the Division of Gynaecology, University Medical Centre Utrecht, The Netherlands.

POPULATION: Women from the PORTRET study experiencing moderate to severe stress urinary incontinence.

METHODS: A validated questionnaire was sent to participants.

MAIN OUTCOME MEASURES: The primary outcome was subjective improvement in urinary incontinence symptoms. Secondary outcomes included subjective cure, severity of incontinence, impact of incontinence as urogenital symptom and cross-over and re-operation rates.

RESULTS: In this long-term study, 184 of 386 (47.7%) women responded to the questionnaire. Cross-over (86.9%) from the initial physiotherapy group to surgery was very high. No statistically significant differences were found in the intention to treat analysis. However, the post hoc analysis showed that women who underwent physiotherapy only reported a statistically significant lower improvement compared to those who underwent initial surgery (50.6% absolute difference; 95% CI 28.2-73.1) or surgery after physiotherapy (49.7% absolute difference; 95% CI 25.8-73.7). Subjective cure, decrease in perceived severity and impact of urinary incontinence also statistically significantly favoured women who underwent (initial) surgery Re-operation was reported by 4.6% of women.

CONCLUSION: This 12-year follow-up study showed a very high cross-over rate to surgical treatment, considering a substantial proportion of non-responders. Midurethral sling surgery, either initial or after physiotherapy, statistically significantly improved subjective outcomes for moderate to severe stress urinary incontinence as compared to pelvic floor muscle physiotherapy only in the long-term.

PMID:39931871 | DOI:10.1111/1471-0528.18092

Curr Cardiol Rev. 2025 Feb 11. doi: 10.2174/011573403X345783250128052038. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric heart failure (HF) poses diagnostic challenges, especially in emergency settings, where misdiagnoses are common.

AIM: This study aimed to investigate the causes of HF in children with congenital heart disease (CHD) and provide insights into age-related disparities and clinical classifications.

METHODS: A prospective observational cohort study was conducted on 402 pediatric patients with CHD during the years 2019-2020. Ultimately, 45 pediatric patients diagnosed with HF by two pediatric cardiologists based on clinical symptoms and radiographic changes were included in the study. Information from the patients’ files, including epidemiological findings, clinical examinations, paraclinical findings, and interventions performed, was recorded. Etiological factors and clinical classifications were analyzed using statistical tests.

RESULTS: Among 402 pediatric patients with CHD, 45 (11.19%) were diagnosed with HF, with a median age of 7.5 months. The predominant etiological factors included ventricular septal defect (VSD), atrial septal defect (ASD), and cardiomyopathy. CHD was prevalent in 86.66% of the cases. Clinical classifications revealed age-related differences, emphasizing the heterogeneity of pediatric HF presentations.

CONCLUSION: Considering that 86.7% of the patients with HF in our study had CHD, more investigations into the causes and mechanisms of this issue are necessary, which will be possible with genetic studies. A significant difference was observed between Class II and Class IV, with Class II patients being older and heavier, and having a lower heart rate compared to those in Class IV. This aligns with the classifications, where Class II indicates mild symptoms during ordinary activity, while Class IV signifies severe symptoms at rest.

PMID:39931850 | DOI:10.2174/011573403X345783250128052038

Chronobiol Int. 2025 Feb 11:1-12. doi: 10.1080/07420528.2025.2460648. Online ahead of print.

ABSTRACT

The aim of the current study was to determine the prevalence of night eating syndrome (NES) among preclinical medical students. All participants were asked to complete a socio-demographic form, Night Eating Questionnaire (NEQ), Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI), Barratt Impulsiveness Scale-11 (BIS-11), Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS), and the Adult Attention Deficit Hyperactivity Disorder Self-report Scale (ASRS). The participants were categorised according to their NEQ scores, and statistical analyses were carried out between the groups. The mean NEQ score of the participants was 16.31 ± 5.48, and 8.8% were diagnosed with probable NES. Those with probable NES had higher MEQ, PSQI, BIS-11, PHQ-15, GAD-7, PHQ-9, ASRS-A and ASRS-B scores. A moderate positive association was identified between the NEQ score and PSQI and PHQ-9. ASRS-B and BIS-11 were found to have a mediating role in the relationship between NES and MEQ. The findings of our study suggest that the prevalence of probable NES in preclinical medical students is higher than the general population, and that NES symptomatology is associated with many psychiatric clinical entities in addition to depressive and sleep disorders included in the diagnostic criteria.

PMID:39931845 | DOI:10.1080/07420528.2025.2460648

J Ment Health Policy Econ. 2024 Dec 1;27(4):129-143.

ABSTRACT

BACKGROUND: Persistent depressive disorder (PDD; chronic depression) is associated with high personal, economic, and societal burden. Patients with PDD often fail to respond to treatment, despite long-term, intensive care, suggesting that future treatment should focus more on functional recovery. The “Patient and Partner Education Program for All Chronic Diseases-Persistent Depressive Disorder” (PPEP4All-PDD) is a brief self-management program for patients with PDD with nine weekly sessions, provided in group or individual format. Its focus on functional recovery may increase quality of life and shorten treatment duration, thus reducing healthcare and societal costs. This study examined the cost-effectiveness of PPEP4All-PDD for adults and elderly with PDD and their partners/caregivers compared to care-as-usual (CAU).

AIMS OF THE STUDY: In this economic evaluation, we examined whether a favorable cost-utility of PPEP4All-PDD compared to CAU could be attained.

METHOD: In this multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were included. Data were collected at 0, 3, 6, and 12 months. Health-related quality of life was measured using the EuroQoL 5-Dimensions/Levels (EQ-5D-5L). Cost of healthcare utilization and productivity loss were assessed using the Trimbos questionnaire for Costs associated with Psychiatric illness (TiC-P). We examined incremental costs per quality-adjusted life years (QALYs) after one year.

RESULTS: In relation to PPEP4All-PDD, 62% (n = 23) of patients had no participating PPEP4All-PDD partner/caregiver, and 89% (n = 33) of patients participated in group format. On average, PPEP4All-PDD cost €232 including the PPEP4All-PDD partner/caregiver, or €166 excluding the partner/caregiver. There was no statistical difference in mean costs per patient for (mental) healthcare, non-healthcare, and societal costs nor in QALYs between PPEP4All-PDD and CAU. The probability that PPEP4All-PDD is cost-effective compared to CAU remained below 50% for all acceptable values of willingness-to-pay for a QALY.

DISCUSSION: This was the first economic evaluation of PPEP4All-PDD. Compared to CAU, PPEP4All-PDD did not lead to lower total healthcare costs nor higher quality of life in the one-year follow-up period. PPEP4All-PDD patients continued to receive additional mental healthcare sessions, showing that the process of ending treatment after a self-management intervention is not clear. The COVID-19 situation may have also affected this process after PPEP4All-PDD, due to higher levels of anxiety and loneliness. We could not confirm that involvement of the partner/caregiver was beneficial to patient treatment outcomes and requires further examination.

IMPLICATIONS: This economic evaluation failed to find significant differences in costs between PPEP4All-PDD and CAU over a study period of one year. Non-significant differences were in favor of CAU, leading to a low probability of PPEP4All-PDD being cost- effective. Providing biweekly sessions and extending the follow-up period may be necessary in future studies. Patients with PDD may require more time to learn and integrate self-management practices into their daily life prior to effecting changes in personal quality of life and (mental) healthcare utilization. Digital interventions, such as digital PPEP4All-PDD, with or without the partner/caregiver may be a cost-effective option.

PMID:39931808

J Ment Health Policy Econ. 2024 Dec 1;27(4):115-128.

ABSTRACT

BACKGROUND: With over 40 million food insecure Americans, access to food is a significant policy challenge. Food insecurity is associated with many adverse health conditions, including poorer mental health outcomes. However, previous research generally does not address that poor mental health can both be a cause and a consequence of food insecurity.

AIMS OF THE STUDY: We estimate the directional causal effect of food insecurity on mental health status and mental health treatment using bounding methods to partially identify the causal effects from food insecurity to mental health status and mental health treatment.

METHODS: Data on food security, mental health status, mental health treatment, and individual and family socioeconomic characteristics for adults come from the nationally representative 2016 and 2017 Medical Expenditure Panel Survey. We use both the continuous score (0-10) of a 10-question module on food security as well as classifying adults as living in households that are food secure (0) or having marginal (1-2), low (3-5), or very low food security (6-10). Mental health status is measured using the Kessler-6 (K6) and the PHQ2 depression screening scales. A K6 score of 13 or greater indicates serious psychological distress while a score of 7 to 12 indicates moderate distress. A score of 3 or more on the PHQ-2 indicates probable depression. Mental health treatment is measured by ambulatory mental health visits, prescriptions for psychotropic medications, and total mental health expenditures. Standard parametric regression models are used as a baseline for partial identification models that bound the effects of food security on mental health. In our preferred specification, we impose the following assumptions: monotone treatment selection (MTS), monotone treatment response (MTR), and monotone instrumental variables (MIV) using household income as an instrument.

RESULTS: Those living in food insecure households are more likely to experience psychological distress and depression than those who in food secure households, but do not seek commensurately more mental health treatment. Non-parametric bounds suggest food insecurity increases the probability of moderate psychological distress by no more than 7.2 percentage points, serious psychological distress by no more than 3 percentage points, and probable depression by no more than 4.2 percentage points. The estimated effect sizes of food security on mental health treatment are much smaller, with treatment uptake increasing by no more than 2.4 percentage points.

DISCUSSION: Our parametric results are consistent with prior findings on the relationship between food security and mental health. We provide evidence for a causal effect of food insecurity which may account for about half the observed association of food security on mental health. A new and previously unreported result indicates that, despite poorer mental health, the food insecure do not show similar increases in mental health care. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE / IMPLICATIONS FOR HEALTH POLICIES: Our results provide policy relevant bounds on the causal impact of food insecurity on mental health. These results raise concerns about the mental health treatment gap in the food insecure population. The relative lack of treatment may point towards deeper structural issues in access to mental health treatment.

PMID:39931807

Addiction. 2025 Feb 11. doi: 10.1111/add.70001. Online ahead of print.

ABSTRACT

BACKGROUND AND AIMS: There is growing evidence that tobacco smoking causes depression, but it is unclear which constituents of tobacco smoke (e.g. nicotine, carbon monoxide) may be responsible. We used Mendelian randomisation (MR) to measure the independent effect of nicotine on depression, by adjusting the effect of circulating nicotine exposure [via nicotine metabolite ratio (NMR)] for the overall effect of smoking heaviness [via cigarettes per day (CPD)] to account for the non-nicotine constituents of tobacco smoke.

DESIGN: Univariable MR and multivariable MR (MVMR) were used to measure the total and independent effects of genetic liability to NMR and CPD on major depressive disorder (MDD). Our primary method was inverse variance weighted (IVW) regression, with other methods as sensitivity analyses.

SETTING AND PARTICIPANTS: For the exposures, we used genome-wide association study (GWAS) summary statistics among European ancestry individuals for CPD (n = 143 210) and NMR (n = 5185). For the outcome, a GWAS of MDD stratified by smoking status was conducted using individual-level data from UK Biobank (n = 35 871-194 881).

MEASUREMENTS: Genetic variants associated with NMR (n = 6) and CPD (n = 53).

FINDINGS: Univariable MR-IVW indicated a causal effect of CPD on MDD [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.23, P = 0.003] but no clear evidence for an effect of NMR on MDD (OR = 0.98, 95% CI = 0.97-1.00, P = 0.134). MVMR indicated a causal effect of CPD on MDD when accounting for NMR (IVW: OR = 1.19, 95% CI = 1.03-1.37, P = 0.017; Egger: OR = 1.13, 95% CI = 0.89-1.43, P = 0.300) and weak evidence of a small effect of NMR on MDD when accounting for CPD (IVW: OR = 0.98, 95% CI = 0.96-1.00, P = 0.057; Egger: OR = 0.98, 95% CI = 0.96-1.00, P = 0.038).

CONCLUSIONS: The role of nicotine exposure in risk of depression cannot be entirely dismissed. However, the causal effect of tobacco smoking increasing depression risk appears to be largely independent of circulating nicotine exposure, which implies the role of alternative causal pathways.

PMID:39931798 | DOI:10.1111/add.70001

Spine (Phila Pa 1976). 2025 Feb 11. doi: 10.1097/BRS.0000000000005248. Online ahead of print.

ABSTRACT

STUDY DESIGN: Monocentric, retrospective, cross-sectional study.

OBJECTIVE: To investigate the age-related normative values of sagittal parameters and establish their relationships in asymptomatic community-dwelling adults aged over 50.

BACKGROUND CONTEXT: Degenerative changes in the spine with aging alter the sagittal balance, causing spine pathologies. However, there was a lack of comprehensive study on age-related normative values of sagittal alignment and their relationship during degenerative evolution.

METHODS: Among a total of 1,370 volunteers, 701 asymptomatic volunteers were recruited. Participants underwent a lateral X-ray, and sagittal parameters were assessed using a customized computer application.

RESULTS: Age showed a stronger correlation with upper arc of thoracic kyphosis (Upper_TK) (r=0.39) compared to sagittal vertical axis (SVA) (r=0.28) and T1_slope (r=0.29). Lumbar lordosis (LL) did not exhibit a significant decrease with age. The geometrical relationship revealed a significant correlation between TK and LL (r=0.52), and LL and pelvic incidence (PI) (r=0.63), as per the equations: TK=Upper_TK+Lower arc of TK (Lower_TK), LL=Upper arc of LL (Upper_arc)+sacral slope (SS), Lower_TK≈Upper_arc, and PI=SS+pelvic tilt (PT). However, after removing intermediate control variables of Lower_TK (Upper_arc) and SS, the correlation between TK, LL, and PI was statistically weak, due to the little to no correlation between Lower_TK (Upper_arc), SS, and PT. Upper_arc (Lower_TK) was a relatively stable parameter with an age-independent value of 15.93±5.61° in elderly adults. For adults aged 60, Upper_TK significantly increased with age, while individuals over 75 exhibited a significant increase in PT and a decrease in SS and LL.

CONCLUSIONS: Our study provided a normative age-related value of spinal sagittal parameters. To assess the spinal sagittal alignment, it was suggested that LL and TK be divided into two tangential arches based on the location of the lordotic or kyphotic apex. This study offered insights for spine surgeons in preparing for surgical corrections.

PMID:39931787 | DOI:10.1097/BRS.0000000000005248

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Sept 28;49(9):1477-1494. doi: 10.11817/j.issn.1672-7347.2024.230539.

ABSTRACT

OBJECTIVES: Persistent pulmonary hypertension of the newborn (PPHN) is a complex disease with poorly understood mechanisms and risk factors. Developing animal models that reflect the pathophysiological characteristics of PPHN is critical for studying its pathogenesis and treatment strategies. This study aims to analyze the applications, methodologies, and evaluation criteria of PPHN animal models through systematic literature analysis, and to provide guidelines for establishing scientific, cost-effective, and reproducible models.

METHODS: Relevant studies published until March 2023 were retrieved from Chinese databases (CNKI, Wanfang, VIP, and SinoMed) and English databases (PubMed, Web of Science, and Embase). Data were extracted on the applications, species, modeling methods and their principles, specific procedures, species and ages of animals used, and time to model establishment, and criteria for evaluating successful model establishment. A database was created and statistical analyses were performed using Excel 2021, with results presented as charts.

RESULTS: A total of 1 157 studies were identified, and 174 met the inclusion criteria. PPHN animal models were primarily used for pathophysiological and mechanistic research (47.70%). The species used including sheep, pigs, rats, cows, and mice, ranked by frequency of use. Modeling methods were categorized into 4 types: Hypoxia exposure (44.69%), prenatal ductus arteriosus (DA) constriction (41.34%), pharmacological induction (8.94%), and combined induction (hypoxia and indomethacin, 5.03%). Each method was associated with specific species and ages. Prenatal DA constriction was exclusively performed in fetal sheep. The time to model establishment varied: Hypoxia exposure typically required >3 days, prenatal DA constriction had a median of 8.5 days, and combined induction took 3 days. Criteria for evaluating successful model establishment were categorized into 5 dimensions: Anatomical structure, histological features, hemodynamic parameters, blood gas analysis, and other physiological indicators. The most common criteria were “right ventricular hypertrophy” and “significant pulmonary arterial pressure elevation”.

CONCLUSIONS: Current methods for modeling PPHN in animals are diverse, each with its strengths and limitations. Researchers should select the method most suitable for their study objectives and budget. Further exploration is needed to develop scientifically robust, cost-effective, and reproducible animal models for PPHN.

PMID:39931778 | DOI:10.11817/j.issn.1672-7347.2024.230539

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Sept 28;49(9):1431-1439. doi: 10.11817/j.issn.1672-7347.2024.230488.

ABSTRACT

OBJECTIVES: Polypoidal choroidal vasculopathy (PCV) is a major cause of vision loss among older adults worldwide and is particularly common in Asians. When the aneurysmal dilatation of blood vessels or the rupture of widened small veins/arteries occurs, it leads to submacular hemorrhage (SMH), which can result in irreversible damage to vision over time. This study aims to evaluate the surgical outcomes and complications of pars plana vitrectomy (PPV) combined with intraoperative subretinal injection of tissue-type plasminogen activator (t-PA) and postoperative intravitreal injection of anti-vascular endothelial growth factor (VEGF) for the treatment of SMH secondary to PCV.

METHODS: Thirteen patients (13 eyes) with SMH secondary to PCV treated at the Eye Center, Xiangya Hospital, Central South University, from September 2020 to December 2021, were included in this study. All patients underwent PPV combined with subretinal injection of t-PA during surgery and received postoperative intravitreal injections of anti-VEGF. Best corrected visual acuity (BCVA), intraocular pressure, absorption of subretinal hemorrhage, progression of the primary lesion, surgical complications, and factors associated with postoperative efficacy were analyzed preoperatively, 1 week postoperatively, 1 month postoperatively, and 6 months postoperatively.

RESULTS: All patients completed the 6-month follow-up, and at the final visit, 100% of the subretinal hemorrhage of 13 patients was completely cleared. BCVA significantly improved at both 1 month and 6 months postoperatively compared to preoperative and 1-week postoperative levels (all P<0.05). Patients over 60 years old and those with lesions located beneath the fovea had statistically significant differences in visual recovery compared to younger patients and those with extrafoveal lesions (P=0.045 and P=0.006, respectively). No significant correlation was found between disease duration, extent of hemorrhage, presence or absence of preoperative vitreous hemorrhage (VH), and visual recovery at 6 months postoperatively (all P>0.05). Ten patients had an intact ellipsoid zone, and 5 patients had an intact retinal pigment epithelium layer, however, the difference in preoperative and postoperative visual acuity between those with and without intact microstructures was not statistically significant (all P>0.05). At the final follow-up, 2 patients had retinal neuroepithelial edema, and 1 patient had retinal pigment epithelium layer detachment. Postoperative complications included 1 patient of macular hole and 1 patient of retinal pigment epithelium layer tear.

CONCLUSIONS: PPV combined with subretinal t-PA injection and postoperative intravitreal anti-VEGF injection effectively clears SMH secondary to PVC with few surgical complications and significantly improves visual function of the patients over 6-month long-term follow-up.

PMID:39931773 | DOI:10.11817/j.issn.1672-7347.2024.230488