Diabetes Care. 2024 Sep 1;47(9):e74-e75. doi: 10.2337/dc24-0653.
NO ABSTRACT
PMID:39190930 | DOI:10.2337/dc24-0653
Tag: pubmed
JMIR Res Protoc. 2024 Aug 27;13:e59846. doi: 10.2196/59846.
ABSTRACT
BACKGROUND: In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes.
OBJECTIVE: Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities.
METHODS: To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030.
RESULTS: Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort.
CONCLUSIONS: Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59846.
PMID:39190916 | DOI:10.2196/59846
J Med Internet Res. 2024 Aug 27;26:e58735. doi: 10.2196/58735.
ABSTRACT
BACKGROUND: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes.
OBJECTIVE: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities.
METHODS: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis.
RESULTS: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective.
CONCLUSIONS: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions.
TRIAL REGISTRATION: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.
PMID:39190910 | DOI:10.2196/58735
JMIR Form Res. 2024 Aug 27;8:e56327. doi: 10.2196/56327.
ABSTRACT
BACKGROUND: The rise of telehealth and telemedicine during the pandemic allowed patients and providers to develop a sense of comfort with telehealth, which may have increased the demand for virtual-first care solutions with spillover effects into venture capital funding.
OBJECTIVE: We aimed to understand the size and type of digital health investments occurring in the prepandemic and pandemic periods.
METHODS: We examined health care companies founded from March 14, 2019, to March 14, 2020 (prepandemic) versus those founded from March 15, 2020, to March 14, 2022, after pandemic onset. Data were obtained from Crunchbase, a publicly available database that catalogs information about venture capital investments for companies. We also compared companies founded prepandemic to those founded after the first year of the pandemic (pandemic steady-state). We performed a Wilcoxon rank sum test to compare median funding amounts. We compared the 2 groups of companies according to the type of funding round raised, geography, health care subcategory, total amount of funding per year since founding, and number of founders.
RESULTS: There were 2714 and 2218 companies founded prepandemic and during the pandemic, respectively. The companies were similarly distributed across geographies in the prepandemic and pandemic periods (P=.46) with no significant differences in the number of founders (P=.32). There was a significant difference in total funding per year since founding between prepandemic and pandemic companies (US $10.8 million vs US $20.9 million; P<.001). The distribution of funding rounds differed significantly for companies founded in prepandemic and pandemic periods (P<.001). On excluding data from the first year of the pandemic, there were 581 companies founded in the pandemic steady-state period from March 14, 2021, to March 14, 2022. Companies founded prepandemic had a significantly greater mean number of founders than those founded during the pandemic (P=.02). There was no significant difference in total funding per year since founding between prepandemic and steady-state pandemic companies (US $10.8 million vs US $14.4 million; P=.34). The most common types of health care companies included wellness, biotech/biopharma, and software companies. Distributions of companies across health care subcategories were not significantly different before and during the pandemic. However, significant differences were identified when data from the first year of the pandemic were excluded (P<.001). Companies founded during the steady-state pandemic period were significantly more likely to be classified as artificial intelligence (7.3% vs 4.7%; P=.005), software (17.3% vs 12.7%; P=.002), and insurance (3.3% vs 1.7%; P=.003), and were significantly less likely to be classified as health care diagnostics (2.4% vs 5.1%; P=.002).
CONCLUSIONS: We demonstrate no significant changes in the types of health care companies founded before versus during the pandemic, although significant differences emerge when comparing prepandemic companies to those founded after the first year of the pandemic.
PMID:39190909 | DOI:10.2196/56327
Rev Esc Enferm USP. 2024 Aug 23;58:e20240107. doi: 10.1590/1980-220X-REEUSP-2024-0107en. eCollection 2024.
ABSTRACT
OBJECTIVE: To evaluate the workload and severity of patients in the Intensive Care Unit (ICU) with COVID-19.
METHOD: Cross-sectional, analytical study carried out in the ICU of a private hospital. All patients over the age of 18 with a diagnosis of COVID-19 admitted from September 2020 to June 2021 were included. Workload assessed by the Nursing Activities Score (NAS), and severity by the Sequential Organ Failure Assessment. Descriptive and inferential analyses were performed.
RESULTS: 217 patients were included, mostly men, mean age 62.41 years, white, obese, non-smokers and sedentary. The average NAS was 84.79. Staffing was in line with legislation and NAS. NAS was not associated with severity. Severity was associated with higher age, gender, comorbidities, sedentary lifestyle, time on mechanical ventilation, hospitalization and death.
CONCLUSION: Workload was high and not associated with severity or outcomes. Severity was associated with demographic and clinical conditions. This study shows the importance of staff sizing, with a view to promoting safety and quality of care.
PMID:39190876 | DOI:10.1590/1980-220X-REEUSP-2024-0107en
Rev Esc Enferm USP. 2024 Aug 23;58:e20240039. doi: 10.1590/1980-220X-REEUSP-2024-0039en. eCollection 2024.
ABSTRACT
OBJECTIVE: To analyze public management actions regarding organ, cell, and tissue transplant procedures and their financial investments in Brazil.
METHOD: Mixed (time and place) ecological study, carried out based on data from the Hospital Information System of the Brazilian Public Health System (SUS) Information Technology Department and the National Transplant System, from 2001 to 2023. Temporal trend analyses, descriptive and inferential statistics were performed.
RESULTS: Organ, cell, and tissue transplants are concentrated in the Southeast region of the country, with increased costs there. The Northeast and South regions of Brazil have the longest waiting list, with an increasing trend (R2 = 0.96), associated with a decreasing trend in the number of transplants (R2 = 0.97).
CONCLUSION: The difference in the total number of transplants and procedures performed among the Brazilian regions represents the need for organization and investments with strategies aimed at training professionals and raising awareness among the population.
PMID:39190875 | DOI:10.1590/1980-220X-REEUSP-2024-0039en
J Clin Oncol. 2024 Aug 27:JCO2400393. doi: 10.1200/JCO.24.00393. Online ahead of print.
ABSTRACT
PURPOSE: Complete mesocolic excision (CME) is being increasingly used for the treatment of right-sided colon cancer, although there is still no strong evidence that CME provides better long-term oncological outcomes than D2 dissection. The controversy is mainly regarding the survival benefit from extended lymph node dissection emphasized by CME.
METHODS: This multicenter, open-label, randomized controlled trial (ClinicalTrials.gov identifier: NCT02619942) was performed across 17 hospitals in China. Patients diagnosed with stage T2-T4aNanyM0 or TanyN + M0 right-sided colon cancer were randomly assigned (1:1) to undergo either CME or D2 dissection during laparoscopic right colectomy. The primary outcome was the 3-year disease-free survival (DFS), and the main secondary outcome was the 3-year overall survival (OS).
RESULTS: Between January 11, 2016, and December 26, 2019, 1,072 patients were randomly assigned (536 patients to CME and 536 patients to D2 dissection). In total, 995 patients (median age 61 years, 59% male) were included in the primary analysis (CME [n = 495] v D2 dissection [n = 500]). No significant differences were found between the groups in 3-year DFS (hazard ratio [HR], 0.74 [95% CI, 0.54 to 1.02]; P = .06; 86.1% in the CME group v 81.9% in the D2 group) or in 3-year OS (HR, 0.70 [95% CI, 0.43 to 1.16]; P = .17; 94.7% in the CME group v 92.6% in the D2 group).
CONCLUSION: This trial failed to find evidence of superior DFS outcome for CME compared with standard D2 lymph node dissection in primary surgical excision of right-sided colon cancer. Standard D2 dissection should be the routine procedure for these patients. CME should only be considered in patients with obvious mesocolic lymph node involvement.
PMID:39190853 | DOI:10.1200/JCO.24.00393
JCO Glob Oncol. 2024 Aug;10:e2400372. doi: 10.1200/GO-24-00372.
NO ABSTRACT
PMID:39190845 | DOI:10.1200/GO-24-00372
Invest Radiol. 2024 Aug 28. doi: 10.1097/RLI.0000000000001118. Online ahead of print.
ABSTRACT
OBJECTIVES: The aim of this study was to evaluate the use of a multicontrast deep learning (DL)-reconstructed 4-fold accelerated 2-dimensional (2D) turbo spin echo (TSE) protocol and the feasibility of 3-dimensional (3D) superresolution reconstruction (SRR) of DL-enhanced 6-fold accelerated 2D Dixon TSE magnetic resonance imaging (MRI) for comprehensive knee joint assessment, by comparing image quality and diagnostic performance with a conventional 2-fold accelerated 2D TSE knee MRI protocol.
MATERIALS AND METHODS: This prospective, ethics-approved study included 19 symptomatic adult subjects who underwent knee MRI on a clinical 3 T scanner. Every subject was scanned with 3 DL-enhanced acquisition protocols in a single session: a clinical standard 2-fold in-plane parallel imaging (PI) accelerated 2D TSE-based protocol (5 sequences, 11 minutes 23 seconds) that served as a reference, a DL-reconstructed 4-fold accelerated 2D TSE protocol combining 2-fold PI and 2-fold simultaneous multislice acceleration (5 sequences, 6 minutes 24 seconds), and a 3D SRR protocol based on DL-enhanced 6-fold accelerated (ie, 3-fold PI and 2-fold simultaneous multislice) 2D Dixon TSE MRI (6 anisotropic 2D Dixon TSE acquisitions rotated around the phase-encoding axis, 6 minutes 24 seconds). This resulted in a total of 228 knee MRI scans comprising 21,204 images. Three readers evaluated all pseudonymized and randomized images in terms of image quality using a 5-point Likert scale. Two of the readers (musculoskeletal radiologists) additionally evaluated anatomical visibility and diagnostic confidence to assess normal and pathological knee structures with a 5-point Likert scale. They recorded the presence and location of internal knee derangements, including cartilage defects, meniscal tears, tears of ligaments, tendons and muscles, and bone injuries. The statistical analysis included nonparametric Friedman tests, and interreader and intrareader agreement assessment using the weighted Fleiss-Cohen kappa (κ) statistic. P values of less than 0.05 were considered statistically significant.
RESULTS: The evaluated DL-enhanced 4-fold accelerated 2D TSE protocol provided very similar image quality and anatomical visibility to the standard 2D TSE protocol, whereas the 3D SRR Dixon TSE protocol scored less in terms of overall image quality due to reduced edge sharpness and the presence of artifacts (P < 0.001). Subjective signal-to-noise ratio, contrast resolution, fluid brightness, and fat suppression were good to excellent for all protocols. For 1 reader, the Dixon method of the 3D SRR protocol provided significantly better fat suppression than the spectral fat saturation applied in the standard 2D TSE protocol (P < 0.05). The visualization of knee structures with 3D SRR Dixon TSE was very similar to the standard protocol, except for cartilage, tendons, and bone, which were affected by the presence of reconstruction and aliasing artifacts (P < 0.001). The diagnostic confidence of both readers was high for all protocols and all knee structures, except for cartilage and tendons. The standard 2D TSE protocol showed a significantly higher diagnostic confidence for assessing tendons than 3D SRR Dixon TSE MRI (P < 0.01). The interreader and intrareader agreement for the assessment of internal knee derangements using any of the 3 protocols was substantial to almost perfect (κ = 0.67-1.00). For cartilage, the interreader agreement was substantial for DL-enhanced accelerated 2D TSE (κ = 0.79) and almost perfect for standard 2D TSE (κ = 0.98) and 3D SRR Dixon TSE (κ = 0.87). For menisci, the interreader agreement was substantial for 3D SRR Dixon TSE (κ = 0.70-0.80) and substantial to almost perfect for standard 2D TSE (κ = 0.80-0.99) and DL-enhanced 2D TSE (κ = 0.87-1.00). Moreover, the total acquisition time was reduced by 44% when using the DL-enhanced accelerated 2D TSE or 3D SRR Dixon TSE protocol instead of the conventional 2D TSE protocol.
CONCLUSIONS: The presented DL-enhanced 4-fold accelerated 2D TSE protocol provides image quality and diagnostic performance similar to the standard 2D protocol. Moreover, the 3D SRR of DL-enhanced 6-fold accelerated 2D Dixon TSE MRI is feasible for multicontrast 3D knee MRI as its diagnostic performance is comparable to standard 2-fold accelerated 2D knee MRI. However, reconstruction and aliasing artifacts need to be further addressed to guarantee a more reliable visualization and assessment of cartilage, tendons, and bone. Both the 2D and 3D SRR DL-enhanced protocols enable a 44% faster examination compared with conventional 2-fold accelerated routine 2D TSE knee MRI and thus open new paths for more efficient clinical 2D and 3D knee MRI.
PMID:39190787 | DOI:10.1097/RLI.0000000000001118
J Osteopath Med. 2024 Aug 23. doi: 10.1515/jom-2022-0187. Online ahead of print.
ABSTRACT
CONTEXT: Prescribing medications is one of the physicians’ most important professional activities throughout their careers. Lack of confidence and competency to prescribe may lead to preventable medical errors. The prevalence of prescription errors among new graduate physicians has been widely studied. Studies have linked this to inadequate foundational pharmacology education and work environment, among other factors. Suggestions were made for different educational interventions to increase the physicians’ confidence and competency in prescribing to reduce the risk of medical errors. However, many of these studies were about students or graduates of medical schools other than osteopathic medical schools.
OBJECTIVES: This study analyzed the self-reported confidence of graduating seniors in the United States osteopathic medical schools in their current ability to prescribe safely and independently and the possible associated factors.
METHODS: This study analyzed secondary data on the graduating seniors’ surveys published by the American Association of Colleges of Osteopathic Medicine (AACOM) from the 2012/2013 to 2020/2021 academic years. Data were analyzed utilizing SPSS version 26.0 and MedCalc version 22.009, and statistical inferences were considered significant whenever p≤0.05.
RESULTS: The aggregated data show that 38,712 Doctor of Osteopathic Medicine (DO) seniors responded to the AACOM survey, representing 72.1 % of expected graduates during the study period. Most of the DO graduating seniors (70.8 %) reported feeling confident in their current abilities to independently write safe and indicated orders and to prescribe therapies or interventions in various settings. The percentage of respondents who perceived the time devoted to clinical pharmacology instruction as appropriate increased systematically over these reported years. A positive correlation was found between the percentage of students who reported the time dedicated to clinical pharmacology as excessive and the percentage of students who reported being confident in prescribing. A statistically significant positive correlation was found between the percentage of students who agreed that the first two years of medical school were well organized and the percentage of students who reported being confident in prescribing. A statistically significant correlation was found between the percentage of students who agreed with statements about frequent interactions with the attendee, testing at the end of each rotation, and being prepared for Comprehensive Osteopathic Medical Licensing Examination Level 2-Cognitive Evaluation (COMLEX Level 2-CE) during the required clerkships and the percentage of students who reported being confident in independent prescribing.
CONCLUSIONS: During this study period, most osteopathic medical graduating seniors (70.8 %) felt confident about their current prescribing abilities; the rest did not, which can increase the risk of preventable medical errors. The prescription confidence may be boosted by more organization for the first 2 years, increasing the time devoted to clinical pharmacology education, and developing more interactive courses during the required clerkships in clinical education.
PMID:39190781 | DOI:10.1515/jom-2022-0187