Tag: pubmed

Eye Contact Lens. 2023 Jul 3. doi: 10.1097/ICL.0000000000001013. Online ahead of print.

ABSTRACT

PURPOSE: To analyze critically the clinical trials on presbyopia correction with contact lenses (CLs) to investigate the quality of the research performed.

METHODS: A search was performed in PubMed database on clinical trials evaluating the efficacy of the presbyopia correction with different CLs, including multifocal or simultaneous vision contact lenses (MCLs). After a comprehensive analysis of the relevant publications found, quality assessment of such publications was performed by means of Critical Appraisal Skills Programme checklist tool according to the five types of evaluations: MCL versus spectacles, MCL versus pinhole CLs, MCL versus monovision, comparison between MCL designs, and MCL versus extended depth of focus CLs.

RESULTS: A total of 16 clinical trials were selected for evaluation. All evaluated studies addressed a clearly focused research question and were randomized, with a crossover design in most of the cases. Blinding was not possible in all cases due to the physical appearance of some of the CLs evaluated (pinhole or hybrid designs). Most of studies analyzed reported outcomes with complete data, providing the statistical tests used and the P-values, but some of the authors did not provide the statistical power associated to the sample size evaluated. The small sample size in some trials as well as the scarce information about the effect of addition on visual performance was the main limitations found in the peer-reviewed literature revised.

CONCLUSIONS: There is a high-quality scientific evidence supporting the use of presbyopia-correcting CLs, with several randomized controlled clinical trials conducted to this date.

PMID:37418305 | DOI:10.1097/ICL.0000000000001013

Eye Contact Lens. 2023 Jul 4. doi: 10.1097/ICL.0000000000001011. Online ahead of print.

ABSTRACT

OBJECTIVES: In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups.

METHODS: The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal.

RESULTS: There was no statistically significant difference between the groups for age and gender (P˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141μm2 and 160.77±65.08 μm, respectively, in the nasal quadrant and 2.623±1.277 μm2 and 158.81±68.05 μm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups (P<0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters.

CONCLUSION: This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.

PMID:37418302 | DOI:10.1097/ICL.0000000000001011

JAMA Netw Open. 2023 Jul 3;6(7):e2322056. doi: 10.1001/jamanetworkopen.2023.22056.

ABSTRACT

IMPORTANCE: Among patients with bipolar disorder, discordant findings have been published on the nephrotoxic effects of lithium therapy.

OBJECTIVE: To quantify absolute and relative risks of chronic kidney disease (CKD) progression and acute kidney injury (AKI) in people who initiated lithium compared with valproate therapy and to investigate the association between cumulative use and elevated lithium levels and kidney outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study had a new-user active-comparator design and used inverse probability of treatment weights to minimize confounding. Included patients initiated therapy with lithium or valproate from January 1, 2007, to December 31, 2018, and had a median follow-up of 4.5 years (IQR, 1.9-8.0 years). Data analysis began in September 2021, using routine health care data from the period 2006 to 2019 from the Stockholm Creatinine Measurements project, a recurrent health care use cohort of all adult residents in Stockholm, Sweden.

EXPOSURES: New use of lithium vs new use of valproate and high (>1.0 mmol/L) vs low serum lithium levels.

MAIN OUTCOMES AND MEASURES: Progression of CKD (composite of >30% decrease relative to baseline estimated glomerular filtration rate [eGFR] and kidney failure), AKI (by diagnosis or transient creatinine elevations), new albuminuria, and annual eGFR decrease. Outcomes by attained lithium levels were also compared in lithium users.

RESULTS: The study included 10 946 people (median [IQR] age, 45 [32-59] years; 6227 female [56.9%]), of whom 5308 initiated lithium therapy and 5638 valproate therapy. During follow-up, 421 CKD progression events and 770 AKI events were identified. Compared with patients who received valproate, those who received lithium did not have increased risk of CKD (hazard ratio [HR], 1.11 [95% CI, 0.86-1.45]) or AKI (HR, 0.88 [95% CI, 0.70-1.10]). Absolute 10-year CKD risks were low and similar: 8.4% in the lithium group and 8.2% in the valproate group. No difference in the risk of developing albuminuria or the annual rate of eGFR decrease was found between groups. Among more than 35 000 routine lithium tests, only 3% of results were in the toxic range (>1.0 mmol/L). Lithium values greater than 1.0 mmol/L, compared with lithium values of 1.0 mmol/L or less, were associated with increased risk of CKD progression (HR, 2.86; 95% CI, 0.97-8.45) and AKI (HR, 3.51; 95% CI, 1.41-8.76).

CONCLUSIONS AND RELEVANCE: In this cohort study, compared with new use of valproate, new use of lithium was meaningfully associated with adverse kidney outcomes, with low absolute risks that did not differ between therapies. However, elevated serum lithium levels were associated with future kidney risks, particularly AKI, emphasizing the need for close monitoring and lithium dose adjustment.

PMID:37418264 | DOI:10.1001/jamanetworkopen.2023.22056

JAMA Netw Open. 2023 Jul 3;6(7):e2322310. doi: 10.1001/jamanetworkopen.2023.22310.

ABSTRACT

IMPORTANCE: Health care delivery faces a myriad of challenges globally with well-documented health inequities based on geographic location. Yet, researchers and policy makers have a limited understanding of the frequency of geographic health disparities.

OBJECTIVE: To describe geographic health disparities in 11 high-income countries.

DESIGN, SETTING, AND PARTICIPANTS: In this survey study, we analyzed results from the 2020 Commonwealth Fund International Health Policy (IHP) Survey-a nationally representative, self-reported, and cross-sectional survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US. Eligible adults older than age 18 years were included by random sampling. Survey data were compared for the association of area type (rural or urban) with 10 health indicators across 3 domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individuals’ age and sex.

MAIN OUTCOMES AND MEASURES: The main outcomes were geographic health disparities as measured by differences in respondents living in urban and rural settings in 10 health indicators across 3 domains.

RESULTS: There were 22 402 survey respondents (12 804 female [57.2%]), with a 14% to 49% response rate depending on the country. Across the 11 countries and 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care), there were 21 occurrences of geographic health disparities; 13 of those in which rural residence was a protective factor and 8 of those where rural residence was a risk factor. The mean (SD) number of geographic health disparities in the countries was 1.9 (1.7). The US had statistically significant geographic health disparities in 5 of 10 indicators, the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. The indicators with the most occurrences of geographic health disparities were in the access to care domain.

CONCLUSIONS AND RELEVANCE: In this survey study of 11 high-income nations, health disparities across 10 indicators were identified. Differences in number of disparities reported by country suggest that health policy and decision makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.

PMID:37418259 | DOI:10.1001/jamanetworkopen.2023.22310

JAMA Netw Open. 2023 Jul 3;6(7):e2322341. doi: 10.1001/jamanetworkopen.2023.22341.

ABSTRACT

IMPORTANCE: Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality.

OBJECTIVE: To investigate the associations of population-level tobacco-control policies with health outcomes.

DATA SOURCES: PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched.

STUDY SELECTION: Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022.

DATA EXTRACTION AND SYNTHESIS: Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

MAIN OUTCOMES AND MEASURES: The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs.

RESULTS: Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events.

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.

PMID:37418258 | DOI:10.1001/jamanetworkopen.2023.22341

Qual Life Res. 2023 Jul 7. doi: 10.1007/s11136-023-03467-1. Online ahead of print.

ABSTRACT

PURPOSE: Patients with heart failure (HF) possess low self-care activation and motivation, leading to a deprived quality of life and adverse mental health conditions. To this end, self-determination theory emphasizes that autonomy-supportive interventions (ASI) can stimulate intrinsic motivation and improve behaviors and quality of life. Nevertheless, studies that focused on ASI for HF are inadequate. This study aims to evaluate the effects of an HF-ASIP on self-care, quality of life and mental health in HF patients.

METHODS: In a two-arm randomized controlled trial, the participants are randomly allocated to the intervention (n = 41) or control (n = 41) groups. The intervention group received routine care and participated in an 8-week HF-ASIP, including individual education and consultation sessions. In contrast, the control group received only routine care. The primary outcome includes self-care management, while the secondary outcomes include self-care maintenance, quality of life, mental health, and motivation. After measuring the outcomes at baseline (T₀), 4-week (T₁), 8-week (T₂), and 12-week (T₃) follow-up, the intervention effects are assessed using the generalized equation models.

RESULTS: The outcomes indicated that self-care management (T₂: P = 0.001; T₃: P = 0.016), self-care maintenance (T₂: P = 0.003; T₃: P = 0.001), depression (T₂: P = 0.007; T₃: P = 0.012), anxiety (T₂: P = 0.001; T₃: P = 0.012), MLHFQ total score (T₁: P = 0.004; T₂: P < 0.001; T₃: P = 0.001), autonomous motivation (T₂: P = .0.006; T₃: P = 0.002) showed statistically difference between the groups.

CONCLUSION: In summary, the 8-week HF-ASIP significantly improved the attributes of self-care, quality of life, mental health, and motivation in HF patients, suggesting the potential for practical intervention effect.

TRIAL REGISTRATION: ChiCTR2100053970.

PMID:37418228 | DOI:10.1007/s11136-023-03467-1

Environ Sci Pollut Res Int. 2023 Jul 7. doi: 10.1007/s11356-023-28438-4. Online ahead of print.

ABSTRACT

The average population in sub-Saharan Africa that has access to clean fuel for cooking and technology is 23.6%. This study examines the panel data for 29 sub-Saharan African (SSA) countries for the period 2000-2018 to estimate impacts of clean energy technologies on environmental sustainability measured by load capacity factor (LCF) to capture both nature’s supply and man’s demand for the environment. The study used generalized quantile regression, which is more robust to outliers and eliminates the endogeneity of variables in the model using lagged instruments. Results show that clean energy technologies (clean fuels for cooking and renewable energy) have positive and statistically significant impacts on environmental sustainability in SSA for almost all quantiles. For robustness checks, we used Bayesian panel regression estimates and the results remained unchanged. The overall results suggest that clean energy technologies improve environmental sustainability in SSA. The result shows a U-shaped relationship between environmental quality and income and confirms the Load Capacity Curve (LCC) hypothesis in SSA, which implies that income first worsens environmental sustainability and then, after exceeding certain quantiles, improves environmental sustainability. On the other hand, the results also confirm the environmental Kuznet curve (EKC) hypothesis in SSA. The findings show the importance of using clean fuels for cooking, trade, and renewable energy consumption in improving environmental sustainability in the region. The policy implication is that governments in SSA should reduce the cost of energy services (i.e., renewable energy and clean fuels for cooking) to achieve greater environmental sustainability in the region.

PMID:37418191 | DOI:10.1007/s11356-023-28438-4

Environ Sci Pollut Res Int. 2023 Jul 7. doi: 10.1007/s11356-023-28394-z. Online ahead of print.

ABSTRACT

Anti-mullerian hormone (AMH) concentration is a marker of ovarian reserve that decreases with age. However, a decrease in AMH may occur more rapidly under the influence of environmental factors. The present study investigated the association between long-term exposure to ambient air pollutants with serum concentrations of AMH and the AMH rate of decline. This study included 806 women with median age of 43 years (interquartile range: 38-48) participating in the Tehran Lipid and Glucose Study (TLGS) that were followed from 2005 to 2017. The AMH concentration and the demographic, anthropometric, and personal health parameters of the study participants were obtained from the TLGS cohort database. Air pollutant data were collected from the monitoring stations and the individual exposures were estimated by previously developed land use regression (LUR) models. Multiple linear regression analysis was used to estimate linear relationships between the air pollutant exposures and serum concentration of AMH and with the AMH declination rate. The results show no statistically significant associations between exposures to any of the air pollutants (including PM₁₀, PM_2.5, SO₂, NO, NO₂, NO_X, and benzene, toluene, ethylbenzene, p-xylene, m-xylene, o-xylene (BTEX), and total BTEX) with serum concentration of AMH. Compared to the first tertile, no statistically significant associations were observed between the second or third tertiles of air pollutants, with the AMH rate of decline. In this study, we did not find significant association between air pollution and AMH in middle age women in Tehran, Iran. Future work may study such associations in younger women.

PMID:37418184 | DOI:10.1007/s11356-023-28394-z

Otolaryngol Head Neck Surg. 2023 Jul 7. doi: 10.1002/ohn.420. Online ahead of print.

ABSTRACT

OBJECTIVE: Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy.

STUDY DESIGN: A retrospective review was performed of patients <18 years of age, referred to a tertiary care children’s hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management.

SETTING: University of California, San Francisco Pediatric Otolaryngology Department.

RESULTS: Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management.

CONCLUSION: The majority of pediatric PACL is benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow-up with neck ultrasound can be used to safely monitor patients.

PMID:37418178 | DOI:10.1002/ohn.420

J Biomol Struct Dyn. 2023 Jul 7:1-10. doi: 10.1080/07391102.2023.2233028. Online ahead of print.

ABSTRACT

The functional domains of BARD1, comprise the Ankyrin Repeat Domain (ARD), C-Terminal domains (BRCTs), and a linker between ARD and the BRCTs, which are known to bind to Cleavage stimulation Factor complex-subunit of 50 kDa (CstF-50). The pathogenic mutation Q564H in the BARD1 ARD-linker-BRCT region has been reported to abrogate the binding between BARD1 and CstF-50. Intermediate penetrance variants of BARD1 are associated with the occurrence of breast cancer. Therefore, seven missense variants of unknown significance (VUS), L447V, P454L, N470S, V507M, I509T, C557S, and Q564H of BARD1, reported in the ARD domain and the linker region were evaluated via molecular dynamics (MD) simulations. The mutants revealed statistically significantly different distributions of RMSD (root mean square deviation), residuewise RMSF (root mean square fluctuation), R_g (radius of gyration), SASA (solvent accessible surface area), and COM (centre of mass)-to-COM distance between the ARD and the BRCT repeat, between the wild type and each mutant. The secondary structural composition of the mutants was slightly altered relative to that of the wild type. However, the reported in-silico based prediction require further validation using in-vitro, biophysical and structure-based approachCommunicated by Ramaswamy H. Sarma.

PMID:37418175 | DOI:10.1080/07391102.2023.2233028