Tag: pubmed

Am J Hosp Palliat Care. 2024 Dec 18:10499091241308883. doi: 10.1177/10499091241308883. Online ahead of print.

ABSTRACT

Background: Patients with primary brain tumors navigate a distinct illness trajectory, characterized by an uncertain prognosis, a rapid decline in physical functioning, and a significant deterioration in the quality of life. These unique challenges underscore the importance of our research in understanding and addressing the needs of these patients. Methods: The EORTC QLQ C30 & EORTC BN 20 questionnaires assessed the quality of life and symptom burden in patients with primary brain tumors. The scores were analyzed using SPSS statistical software. Results: 100 patients – 61 males and 39 females-were included with radiological or histopathological diagnoses of primary brain tumours. Seizures (38%) was the most common presenting symptom, followed by headache (18%), loss of consciousness (13%), focal neurological deficit (9%), and blurring of vision (8%). The mean quality of life at baseline was 78.29, with a standard deviation of 9.67 on a scale of 0 to 100, and the brain tumor-specific symptom burden score was 46.9, with a standard deviation of 17.95 on a scale of 0 to 100. There was a significant difference in the global health status score between the first and third visits at 3 months (P value = .03). Conclusion: Despite the aggressive and often incurable nature of primary brain tumors, there is hope in the form of palliative care. By addressing unmet symptoms, uncertainties about the future, and social functioning, palliative care can significantly improve the quality of life of these patients.

PMID:39695347 | DOI:10.1177/10499091241308883

Int J Obes (Lond). 2024 Dec 18. doi: 10.1038/s41366-024-01698-x. Online ahead of print.

ABSTRACT

BACKGROUND: Evidence on the age-dependent association between adiposity and risk of dementia in the Chinese population is unclear. We aim to disentangle the association of mid- and late- life adiposity with subsequent dementia risk in Chinese adults and compare ageing trajectories of adiposity between those with/out dementia.

METHODS: Dementia was ascertained based on cognitive batteries and the Activity of Daily Living Scale in the China Health and Retirement Longitudinal Study (CHARLS). Adiposity was measured by body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WtHR). We estimated hazard ratio (HR) of adiposity for incident dementia by age groups (i.e. 50-64, and ≥65). Age trajectories of adiposity measures were fitted using a mixed-effect model in a case-control design. The interaction terms of age and dementia were included to examine the difference between cases and controls.

RESULTS: Hazard ratios (HRs) for incident dementia in two age groups (50-64 and ≥65) were estimated in 13,355 participants. Raised mid-life BMI was associated with incident dementia (HR (95% CI): overweight 1.33 (1.03 to 1.73), obesity 1.63 (1.17 to 2.28)). Mid-life abdominal obesity was associated with incident dementia (WC 1.45 (1.15 to 1.84), WtHR 1.44 (1.08 to 1.94)), accounting for ≤24.2% of dementia cases. Among participants developing dementia, adiposity measures were higher in mid-life and declined faster with age, compared to those remaining dementia-free. Late-life adiposity was not associated with dementia risk.

CONCLUSION: Mid-life but not late-life adiposity was associated with dementia incidence in China. Accelerated weight loss in prodromal dementia is likely to explain the mixed evidence on adiposity and dementia risk in the Chinese population. Rapid decline in adiposity in later life may be an early sign. Reducing mid-life adiposity in the population may mitigate the future dementia burden.

PMID:39695279 | DOI:10.1038/s41366-024-01698-x

Sci Total Environ. 2024 Dec 17;958:178066. doi: 10.1016/j.scitotenv.2024.178066. Online ahead of print.

ABSTRACT

Aerobiology in the tropics is still a science in development, where very little about their dynamics is known. Airborne pollen concentrations in the city of Medellín (Colombia) were measured using a Hirst-type sampler and correlated with meteorological parameters (relative humidity, rainfall, temperature, wind speed, and wind direction, this last analyzed by using circular statistics). Sampling was conducted over three years (2019-2022), and pollen grains were detected on all days of sampling, at higher concentrations than expected for tropical conditions. The highest pollen concentrations were observed from December to January and July-August, corresponding to the months with the lowest rainfall, which sheds light about how La Niña phenomena influenced pollen concentrations during the sampling period. The Main Pollen Season (MPS) ranged in length from 277 to 342 days. The highest intra-diurnal peaks pollen concentrations occurred around noon, whilst something very different and rarely reported occurs with Cecropia, which is much more abundant at night, from 20:00 to 1:00 h. Circular statistics revealed statistically significant wind direction patterns from SW, matching the same intra-diurnal pollen variations. This work helps to complete the blurred situation of the Aerobiology in the Neotropics and the dynamics of particles in the tropical atmosphere, being a first step towards the construction of pollen calendars to help pollen sufferers to mitigate symptoms.

PMID:39693665 | DOI:10.1016/j.scitotenv.2024.178066

J Craniofac Surg. 2024 Dec 18. doi: 10.1097/SCS.0000000000011008. Online ahead of print.

ABSTRACT

It is important to investigate the changes in the masseter muscle, one of the chewing muscles, in epilepsy patients and to determine whether epilepsy can be effectively predicted on muscle. The aim of this study is to measure masseter muscle thickness, circumference and cross-sectional area in individuals with epilepsy and healthy individuals. This study was performed with 128 individuals (64 epilepsy patients and 64 healthy subjects) aged between 18 to 59 years. The mean cross-sectional area, thickness and circumference determined by measuring both of the masseter muscles were using cone beam computed tomography. The mean right masseter muscle cross-sectional area varied across age groups in epilepsy individuals (P=0.020). Significant differences were observed in the right masseter muscle circumference among age groups in epilepsy individuals (P=0.003). Significant differences were observed in the mean among age groups in epilepsy individuals (P=0.004). Statistically significant differences were observed in the mean right masseter muscle cross-sectional area between sexes in healthy individuals (P<0.001). Similarly, significant differences were observed in the mean right masseter muscle thickness between sexes in healthy individuals (P<0.001). Significant differences were observed in the mean left masseter muscle cross-sectional area between sexes in healthy individuals (P<0.001). Although jaw joint’s muscular dislocations are common, the masseter muscle, which has a very strong function in masticatory movements, is very important in terms of location, neighbourhood and clinical aspects. For this reason, our study examining the masseter muscle morphometric measurements in the epileptic and healthy population using cone beam computed tomography provides important information and normative data.

PMID:39693628 | DOI:10.1097/SCS.0000000000011008

NEJM Evid. 2024 Dec 18:EVIDoa2400190. doi: 10.1056/EVIDoa2400190. Online ahead of print.

ABSTRACT

BACKGROUND: Data from randomized trials evaluating the effectiveness of tuberculosis (TB) preventive treatment for contacts of multidrug-resistant (MDR)-TB are lacking. Two recently published randomized trials that did not achieve statistical significance provide the opportunity for a meta-analysis.

METHODS: We conducted combined analyses of two phase 3 trials of levofloxacin MDR-TB preventive treatment – Levofloxacin for the Prevention of Multidrug-Resistant Tuberculosis (VQUIN) trial and the Levofloxacin preventive treatment in children exposed to MDR-TB (TB-CHAMP) trial. Following MDR-TB household exposure, VQUIN enrolled mainly adults in Vietnam; TB-CHAMP enrolled mainly young children in South Africa. Random assignment in both trials was 1:1 at the household level to daily levofloxacin or placebo for 6 months. The primary outcome was incident TB by 54 weeks. We estimated the treatment effect overall using individual participant data meta-analysis.

RESULTS: The VQUIN trial (n=2041) randomly assigned 1023 participants to levofloxacin and 1018 participants to placebo; TB-CHAMP (n=922) assigned 453 participants to levofloxacin and 469 participants to placebo. Median age was 40 years (interquartile range 28 to 52 years) in VQUIN and 2.8 years (interquartile range 1.3 to 4.2 years) in TB-CHAMP. Overall, 8 levofloxacin-group participants developed TB by 54 weeks versus 21 placebo-group participants; the relative difference in cumulative incidence was 0.41 (95% confidence interval [CI] 0.18 to 0.92; P=0.03). No association was observed between levofloxacin and grade 3 or above adverse events (risk ratio 1.07, 95% CI 0.70 to 1.65). Musculoskeletal events of any grade occurred more frequently in the levofloxacin group (risk ratio 6.36, 95% CI 4.30 to 9.42), but not among children under 10 years of age. Overall, four levofloxacin-group participants and three placebo-group participants had grade 3 events.

CONCLUSIONS: In this meta-analysis of two randomized trials, levofloxacin was associated with a 60% relative reduction in TB incidence among adult and child household MDR-TB contacts, but with an increased risk of musculoskeletal adverse events. (Funded by the Australian National Health and Medical Research Council, UNITAID, and others.).

PMID:39693627 | DOI:10.1056/EVIDoa2400190

J Med Internet Res. 2024 Dec 18;26:e56897. doi: 10.2196/56897.

ABSTRACT

BACKGROUND: With 1 in 3 adults globally living with chronic conditions and the rise in smartphone ownership, mobile health apps have become a prominent tool for managing lifestyle-related health behaviors and mental health. However, high rates of app abandonment pose challenges to their effectiveness.

OBJECTIVE: We explored the abandonment of apps used for managing physical activity, diet, alcohol, smoking, and mental health in free-living conditions, examining the duration of app use before abandonment and the underlying reasons.

METHODS: A scoping review was conducted based on the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and eligibility criteria were designed according to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. In total, 4 databases were searched (MEDLINE, Scopus, Embase, and PsycINFO) to identify quantitative and qualitative studies with outcome measures related to app abandonment in adults with free-living conditions, including reasons for abandonment and duration of use, for mobile apps related to WHO (World Health Organization) modifiable health behaviors and mental health. The included studies’ risk of bias was appraised based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and COREQ (Consolidated Criteria for Reporting Qualitative Research) checklists. To enable data synthesis across different methodologies, app domains, demographic data, and outcome measures were categorized. Results are presented in 2 sections: quantitatively in a scatterplot to understand when users abandon apps and qualitatively through basic qualitative content analysis to identify the underlying reasons.

RESULTS: Eighteen eligible studies (525,824 participants) published between 2014 and 2022, predominantly from the United States, Canada, the United Kingdom, and Germany, were identified. Findings revealed a curvilinear pattern of app abandonment, with sharper abandonment soon after acquisition, followed by a slowing rate of abandonment over time. Taken together, a median of 70% of users discontinued use within the first 100 days. The abandonment rate appeared to vary by app domain, with apps focusing on alcohol and smoking exhibiting faster abandonment, and physical activity and mental health exhibiting longer usage durations. In total, 22 unique reasons for abandonment were organized into six categories: (1) technical and functional issues, (2) privacy concerns, (3) poor user experience, (4) content and features, (5) time and financial costs, and (6) evolving user needs and goals.

CONCLUSIONS: This study highlights the complex nature of health app abandonment and the need for an improved understanding of user engagement over time, underscoring the importance of addressing various factors contributing to abandonment, from technical issues to evolving user needs. Our findings also emphasize the need for longitudinal studies and a consistent definition of app abandonment to better understand and mitigate this phenomenon, thereby enhancing the effectiveness of health apps in supporting public health initiatives.

PMID:39693620 | DOI:10.2196/56897

J Med Internet Res. 2024 Dec 18;26:e55176. doi: 10.2196/55176.

ABSTRACT

BACKGROUND: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients’ abilities and health status on the adoption of these interventions.

OBJECTIVE: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM).

METHODS: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM.

RESULTS: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness (β=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage.

CONCLUSIONS: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care.

PMID:39693615 | DOI:10.2196/55176

Neurology. 2025 Jan 14;104(1):e210129. doi: 10.1212/WNL.0000000000210129. Epub 2024 Dec 18.

ABSTRACT

BACKGROUND AND OBJECTIVES: Antibiotics rapidly reduce intestinal bacterial diversity, leading to dysbiosis that persists for months to years. Although emerging evidence from retrospective and claims-based studies has linked dysbiosis to cognitive function, prospective data are lacking. We aim to examine the prospective association of antibiotics with cognitive aging among initially healthy older adults.

METHODS: We leveraged data from prospective follow-up and observational extension of ASPirin in Reducing Events in the Elderly, a completed randomized trial of community-based Australian older adults. Among participants whose prescription records were available and without dementia during the first 2 years of follow-up, we identified any or repeated antibiotic use based on the Anatomical Therapeutic Chemical code (J01). We assessed the associations of antibiotic use during the first 2 years with longitudinal changes in standardized composite and domain-specific cognitive scores (global cognition, episodic memory, language and executive function, and psychomotor speed) using linear mixed models, and with incident, clinically adjudicated dementia (Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria) and incident cognitive impairment, no dementia (CIND, without a dementia trigger but with significant, nontransient decline), using Cox proportional hazard models.

RESULTS: Over a median of 4.7 years after the second follow-up visit, we documented 461 dementia and 2,576 CIND cases among 13,571 participants (mean age ± SD 75.0 ± 4.1 years, 54.3% female). Compared with nonuse, antibiotic use was not associated with increased risks for dementia (hazard ratio [HR] 1.03; 95% CI 0.84-1.25), CIND (HR 1.02; 95% CI 0.94-1.11), or subsequent declines in cognitive scores, after adjusting for sociodemographic, lifestyle factors, family history of dementia, baseline cognitive function, and medications known to affect cognition. There were also no associations according to the cumulative frequency of antibiotic use, long-term use, specific antibiotic classes (e.g., beta-lactams, tetracyclines, and sulfonamides), and subgroups defined by risk factors.

DISCUSSION: Among initially healthy older adults, any or repeated antibiotic use was not associated with incident dementia, CIND, or accelerated cognitive decline. Although prescription data may not reflect the actual use, we examined the frequency of antibiotics within a defined period to capture the extent and duration of antibiotic exposure. Our results do not support an association between antibiotic-associated gut microbiome disruption and dementia risk.

PMID:39693592 | DOI:10.1212/WNL.0000000000210129

Ophthalmic Epidemiol. 2024 Dec 18:1-4. doi: 10.1080/09286586.2024.2434247. Online ahead of print.

ABSTRACT

PURPOSE: Diabetic eye disease, namely diabetic retinopathy (DR), remains a leading cause of preventable blindness worldwide. Research has shown that treatment for diabetes and eye care was disrupted during the pandemic – with disparities between urban and rural populations being unknown. Thus, we aimed to assess the prevalence of reported rates of DR and dilated fundus exams from 2017 to 2021.

METHODS: We performed a cross-sectional analysis using data from the Behavioral Risk Factor Surveillance System (BRFSS). Among US residents with diabetes, we calculated the rates of DR and annual dilated fundus exams – overall and by metropolitan statistical area (MSA) – measuring differences using X² tests.

RESULTS: In 2017, the rate of DR was 19.78% among US residents reporting diabetes, which increased to the highest rate in 2018 at 22.19% before dropping to the lowest rates in 2019 and 2020 (18.44%). These annual changes were statistically significant (p < .001), but we found no significant differences by MSA status. Each year, nearly ⅔ of all individuals reported receiving dilated fundus examinations which peaked in 2019 at 71.5%. These annual deviations, as well as deviations by MSA were statistically significant (p < .001).

CONCLUSION: Although populations outside of an MSA experienced an increase in dilated fundus examinations, the national prevalence of DR continues to rise. Further research into sociodemographic and cultural factors influencing diabetic eye disease and access to ophthalmic care will be crucial for the prevention of DR and improving vision outcomes.

PMID:39693586 | DOI:10.1080/09286586.2024.2434247

JCO Clin Cancer Inform. 2024 Dec;8:e2400108. doi: 10.1200/CCI.24.00108. Epub 2024 Dec 18.

ABSTRACT

PURPOSE: Postsustained virologic response (SVR) screening following clinical guidelines does not address individual risk of hepatocellular carcinoma (HCC). Our aim is to provide tailored screening for patients using machine learning to predict HCC incidence after SVR.

METHODS: Using clinical data from 1,028 SVR patients, we developed an HCC prediction model using a random survival forest (RSF). Model performance was assessed using Harrel’s c-index and validated in an independent cohort of 737 SVR patients. Shapley additive explanation (SHAP) facilitated feature quantification, whereas optimal cutoffs were determined using maximally selected rank statistics. We used Kaplan-Meier analysis to compare cumulative HCC incidence between risk groups.

RESULTS: We achieved c-index scores and 95% CIs of 0.90 (0.85 to 0.94) and 0.80 (0.74 to 0.85) in the derivation and validation cohorts, respectively, in a model using platelet count, gamma-glutamyl transpeptidase, sex, age, and ALT. Stratification resulted in four risk groups: low, intermediate, high, and very high. The 5-year cumulative HCC incidence rates and 95% CIs for these groups were as follows: derivation: 0% (0 to 0), 3.8% (0.6 to 6.8), 26.2% (17.2 to 34.3), and 54.2% (20.2 to 73.7), respectively, and validation: 0.7% (0 to 1.6), 7.1% (2.7 to 11.3), 5.2% (0 to 10.8), and 28.6% (0 to 55.3), respectively.

CONCLUSION: The integration of RSF and SHAP enabled accurate HCC risk classification after SVR, which may facilitate individualized HCC screening strategies and more cost-effective care.

PMID:39693579 | DOI:10.1200/CCI.24.00108