Tag: pubmed

Urol Pract. 2023 Jul 3:101097UPJ0000000000000429. doi: 10.1097/UPJ.0000000000000429. Online ahead of print.

ABSTRACT

INTRODUCTION: Citing high costs, limited diagnostic benefit, and ionizing radiation-associated risk from CT urogram, in 2020 the American Urological Association revised its guidelines from recommending CT urogram for all patients with microscopic hematuria to a deintensified risk-stratified approach, including the deimplementation of low-value CT urogram (ie, not recommending CT urogram for patients with low- to intermediate-risk microscopic hematuria). Adherence to revised guidelines and reasons for continued low-value CT urogram are unknown.

METHODS: With the overarching objective of improving guideline implementation, we used a mixed-method convergent explanatory design with electronic health record data for a retrospective cohort at a single academic tertiary medical center in the southeastern United States and semistructured interviews with urology and nonurology providers to describe determinants of low-value CT urogram following guideline revision.

RESULTS: Of 391 patients with microscopic hematuria, 198 (51%) had a low-value CT urogram (136 [69%] pre-guideline revision, 62 [31%] postrevision). The odds of ordering a low-value CT urogram were lower after guideline revisions, but the change was not statistically significant (OR: 0.44, P = .08); odds were 1.89 higher (P = .06) among nonurology providers than urology providers, but the difference was not statistically significant. Provider interviews suggested low-value CT urogram related to nonurology providers’ limited awareness of revised guidelines, the role of clinical judgment in microscopic hematuria evaluation, and professional and patient influences.

CONCLUSIONS: Our findings suggest low-value CT urogram deimplementation may be improved with guidelines and implementation support directed at both urology and nonurology providers and algorithms to support guideline-concordant microscopic hematuria evaluation approaches. Future studies should test these strategies.

PMID:37499130 | DOI:10.1097/UPJ.0000000000000429

Br J Surg. 2023 Jul 27:znad231. doi: 10.1093/bjs/znad231. Online ahead of print.

ABSTRACT

BACKGROUND: Colorectal cancer is the third most common cancer, with nearly 2 million cases worldwide and just under 1 million deaths in 2020. Several trials have demonstrated that aspirin has the potential to reduce the incidence and/or recurrence of colorectal cancer; however, the optimal aspirin dose is unclear.

METHODS: Relevant studies were identified by searching MEDLINE, Embase and the Cochrane Library from database inception to 2 February 2022. Data from RCTs in which the incidence of colorectal cancer in patients without active colorectal cancer assigned to aspirin versus control were included. Two investigators independently identified studies and abstracted data. Study quality was assessed using Cochrane Collaboration risk-of-bias 2 tool. The study was performed according to PRISMA guidelines. Aspirin dose was stratified into low (50-163 mg/day), mid (164-325 mg/day), and high (500-1200 mg/day).

RESULTS: Thirteen articles representing 11 RCTs (92 550 participants) were included, with studies assessing aspirin as primary prophylaxis in general or high-risk populations, and as secondary prophylaxis for metachronous colorectal cancer. There was a statistically significant reduction in colorectal cancer incidence in the high-dose aspirin group compared with the group that received no aspirin or placebo (OR 0.69, 95 per cent credible interval 0.50 to 0.96; surface under the cumulative ranking 0.82). There was no statistically significant difference between mid- and low-dose aspirin versus no aspirin/placebo.

CONCLUSION: In this network meta-analysis of RCTs, high-dose aspirin was associated with a reduction in colorectal cancer incidence. However, this was based on a limited number of trials. This study did not show a statistically significant risk reduction in colorectal cancer incidence with mid- or low-dose aspirin.

PMID:37499126 | DOI:10.1093/bjs/znad231

AIDS Care. 2023 Jul 27:1-7. doi: 10.1080/09540121.2023.2240066. Online ahead of print.

ABSTRACT

Understanding motivations and resilience-associated factors that help people newly diagnosed with HIV link to care is critical in the context of universal test and treat. We analyzed 30 in-depth interviews (IDI) among adults aged 18 and older in western Kenya diagnosed with HIV during home-based counseling and testing and who had linked to HIV care. A directed content analysis was performed, categorizing IDI quotations into a table based on linkage stages for organization and then developing and applying codes from self-determination theory and the concept of resilience. Autonomous motivations, including internalized concerns for one’s health and/or to provide care for family, were salient facilitators of accessing care. Controlled forms of motivation, such as fear or external pressure, were less salient. Social support was an important resilience-associated factor fostering linkage. HIV testing and counseling programs which incorporate motivational interviewing that emphasizes motivations related to one’s health or family combined with a social support/navigator approach, may promote timely linkage to care.

PMID:37499119 | DOI:10.1080/09540121.2023.2240066

J Sports Sci. 2023 Jul 27:1-15. doi: 10.1080/02640414.2023.2241782. Online ahead of print.

ABSTRACT

Direct and moderation effects of swimming competence using an integrated model of self-determination theory (SDT) and theory of planned behaviour (TPB) were examined in two large-scale studies among young children. Specifically, we examined whether swimming competence had direct and moderation effects on social psychological variables of perceived need support, autonomous motivation, TPB social cognition constructs, and intention. In Study 1, using a cross-sectional survey of 4959 primary school children, swimming competence formed significant positive relationships with all model variables (β =.061 to.330, p < .05) except intention (β = -.009, p > .05), and its moderation effect on model parameters were small in size or not statistically significant. In Study 2, using a pre-post-test quasi-experiment among 1,609 primary school children, improvement of swimming competence was associated with change-scores in all model variables (β =.046 to.230, p < .05) except subjective norm (β =.049, p > .05). Swimming competence did not significantly moderate the parameter estimates of the integrated model (p > .05) at the change-score level. Findings indicate that swimming competence is associated with higher autonomous motivation; TPB social cognitions of attitude, subjective norm, and perceived behavioural control; and intention. However, swimming competence did not moderate the parameter estimates of the integrated model.

PMID:37499112 | DOI:10.1080/02640414.2023.2241782

Swiss Med Wkly. 2023 Jul 27;153:40103. doi: 10.57187/smw.2023.40103.

ABSTRACT

OBJECTIVES: Active surveillance for low-risk prostate cancer closely monitors patients conservatively instead of the pursuit of active treatment to reduce overtreatment of insignificant disease. Since 2009, active surveillance has been recommended as the primary management option in the European Association of Urology guidelines for low-risk disease. The present study aimed to investigate the use and uptake of active surveillance over 10 years in our certified prostate cancer centre (University Hospital of Zurich) compared with those derived from the cancer registry of the canton of Zurich, Switzerland.

MATERIALS AND METHODS: We retrospectively identified all men diagnosed with low-risk prostate cancer at our institution and from the cancer registry of the canton of Zurich from 2009 to 2018. The primary treatment of each patient was recorded. Descriptive statistics were used to analyze the use of different treatments in our centre. The results were compared with those derived from the cancer registry.

RESULTS: A total of 3393 men with low-risk prostate cancer were included in this study (University Hospital of Zurich: n = 262; cancer registry: n = 3131). In the University Hospital of Zurich and cancer registry cohorts, 146 (55.7%) and 502 (16%) men underwent active surveillance, respectively. The proportions of local treatment [115 (43.9%) vs 2220 (71%)] and androgen deprivation therapy [0 (0%) vs 43 (1.4%)] were distinctly lower in the University Hospital of Zurich cohort than in the cancer registry cohort. The uptake of active surveillance over the years was high in the University Hospital of Zurich cohort (35.4% in 2009 and 88.2% in 2018) but only marginal in the cancer registry cohort (12.2% in 2009 and 16.2% in 2018).

CONCLUSION: Despite clear guideline recommendations, active surveillance for low-risk prostate cancer is still widely underused. Our analysis showed that access to a certified interdisciplinary tumour board significantly increases the use of active surveillance.

PMID:37499067 | DOI:10.57187/smw.2023.40103

Oral Dis. 2023 Jul 27. doi: 10.1111/odi.14682. Online ahead of print.

ABSTRACT

BACKGROUND: Observational studies have found associations between smoking, alcohol, radiation, body mass index (BMI), periodontitis, and the hazard of benign salivary gland neoplasms (BSGNs). Nevertheless, the etiology of BSGNs remains unclear. This study aims to assess the causal association between these modifiable factors and the BSGNs.

METHODS: Genetic instruments associated with exposures at the genome-wide significance level were selected from corresponding genome-wide association studies. The summary statistics for BSGNs were obtained from the FinnGen consortium (2445 cases and 340,054 controls). The inverse variance-weighted method was used as the primary analysis, and several sensitivity analyses were performed to test the reliability.

RESULTS: Genetically predicted higher lifetime smoking index (odds ratio [OR] = 2.10, p = 0.012) and BMI (OR = 1.58, p = 2.29 × 10^-5 ) were associated with elevated risk of BSGNs, whereas other exposures do not. Sensitivity analyses showed consistency. The causal effect of the lifetime smoking index became more significant after adjusting for BMI (OR = 2.89, p = 0.005) and alcohol consumption (OR = 2.49, p = 0.002). A slight negative association emerged for alcohol consumption with adjustment for cigarettes per day (OR = 0.53, p = 0.034) but disappeared when adjusting for cigarettes per day and BMI.

CONCLUSION: This study supports the independent causal role of lifetime smoking index and BMI in BSGNs risk.

PMID:37499050 | DOI:10.1111/odi.14682

Science. 2023 Jul 28;381(6656):404-408. doi: 10.1126/science.add8424. Epub 2023 Jul 27.

ABSTRACT

We studied the effects of exposure to reshared content on Facebook during the 2020 US election by assigning a random set of consenting, US-based users to feeds that did not contain any reshares over a 3-month period. We find that removing reshared content substantially decreases the amount of political news, including content from untrustworthy sources, to which users are exposed; decreases overall clicks and reactions; and reduces partisan news clicks. Further, we observe that removing reshared content produces clear decreases in news knowledge within the sample, although there is some uncertainty about how this would generalize to all users. Contrary to expectations, the treatment does not significantly affect political polarization or any measure of individual-level political attitudes.

PMID:37499012 | DOI:10.1126/science.add8424

Science. 2023 Jul 28;381(6656):398-404. doi: 10.1126/science.abp9364. Epub 2023 Jul 27.

ABSTRACT

We investigated the effects of Facebook’s and Instagram’s feed algorithms during the 2020 US election. We assigned a sample of consenting users to reverse-chronologically-ordered feeds instead of the default algorithms. Moving users out of algorithmic feeds substantially decreased the time they spent on the platforms and their activity. The chronological feed also affected exposure to content: The amount of political and untrustworthy content they saw increased on both platforms, the amount of content classified as uncivil or containing slur words they saw decreased on Facebook, and the amount of content from moderate friends and sources with ideologically mixed audiences they saw increased on Facebook. Despite these substantial changes in users’ on-platform experience, the chronological feed did not significantly alter levels of issue polarization, affective polarization, political knowledge, or other key attitudes during the 3-month study period.

PMID:37498999 | DOI:10.1126/science.abp9364

Psychol Rep. 2023 Jul 27:332941231191066. doi: 10.1177/00332941231191066. Online ahead of print.

ABSTRACT

For unconscious perception research, Bayesian statistics are more appropriate for assessing null awareness of masked stimuli than traditional (frequentist) statistics. This assertion is based mostly upon the theoretical features of Bayesian statistics and modeling studies. To further assess the potential advantages, we compared frequentist and Bayesian statistical tests in a masked Stroop priming experiment in which the prime stimuli were presented at varying degrees of visibility. A novel contribution was to compare a null awareness dissociation approach (i.e., stimulus awareness = 0) to a relative sensitivity approach (indirect or priming effects > direct effects) for the same data. From a null awareness perspective, the frequentist t-tests for the Stroop effect (i.e., perception) for the briefest display conditions had non-significant outcomes. Similar Bayesian t-tests were inconclusive. In contrast, the relative sensitivity dissociation approach was more interpretable, with strong evidence against unconscious perception from a single Bayesian t test. For the longer display conditions, both statistical approaches suggested large conscious perception effects. We conclude that the utility of Bayesian statistics is highly dependent upon the type of dissociation approach, with a relative sensitivity approach being more straightforward to interpret than a null awareness approach.

PMID:37498991 | DOI:10.1177/00332941231191066

J Med Internet Res. 2023 Jul 27;25:e44079. doi: 10.2196/44079.

ABSTRACT

BACKGROUND: Children’s conduct and emotional problems increased during the COVID-19 pandemic.

OBJECTIVE: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep).

METHODS: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models.

RESULTS: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=-0.01) or T3 (secondary outcome; standardized effect=-0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=-0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded.

CONCLUSIONS: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

PMID:37498669 | DOI:10.2196/44079