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Nevin Manimala Statistics

Eating disorders – what the gastroenterologist needs to know

Z Gastroenterol. 2023 May 8. doi: 10.1055/a-2010-3883. Online ahead of print.

ABSTRACT

Eating disorders are potentially life-threatening disorders that go along with severe psychiatric and somatic comorbidities. It is expected that the number of patients will dramatically increase in the post COVID-19 pandemic era.Four main eating disorders are mentioned in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) and the International Classification of Diseases 11 (ICD-11): anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) und avoidant restrictive food intake disorder (ARFID). Many traditional assumptions in eating disorders are currently challenged due to recent research results. The gastroenterologist is usually not the first point of contact for patients with eating disorders. However, he is crucial, especially in the management of gastroenterologic complications of eating disorders.Focus of the overview will be on relevant gastroenterologic aspects and less on the psychiatric treatment. Basics of the most common eating disorders will be repeated, opportunities in diagnosing an eating disorder and the most relevant gastroenterologic complications will be described. Obesity and its management, an entity that often goes along with an eating disorder, is not in the spotlight of the review.

PMID:37156504 | DOI:10.1055/a-2010-3883

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Increased cardiovascular events in young patients with mental disorders: a nationwide cohort study

Eur J Prev Cardiol. 2023 Apr 28:zwad102. doi: 10.1093/eurjpc/zwad102. Online ahead of print.

ABSTRACT

AIMS: It remains unclear whether young patients with mental disorders have a higher risk of cardiovascular diseases than does the general population. Using a nationwide database, we investigated the prognostic association between the risks of myocardial infarction (MI), ischaemic stroke (IS), and mental disorders in young patients.

METHODS AND RESULTS: Young patients aged between 20 and 39 years old who underwent nationwide health examinations between 2009 and 2012 were screened. A total of 6 557 727 individuals were identified and subsequently classified according to mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients were then followed up for MI and IS until December 2018. Patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts. During the follow-up period (median, 7.6 years; interquartile range, 6.5-8.3), 16 133 cases of MI and 10 509 cases of IS occurred. Patients with mental disorders had higher risks of MI (log-rank P = 0.033 in eating disorder and log-rank P < 0.001 in all other mental disorders). Patients with mental disorders had higher risks of IS except post-traumatic stress disorder (log-rank P = 0.119) and eating disorder (log-rank P = 0.828). After adjusting for covariates, the overall diagnosis and each mental disorder were independently associated with increased cardiovascular endpoints.

CONCLUSION: Mental disorders in young patients may have deleterious effects which increase the incidence of MI and IS. Prevention efforts are needed to prevent MI and IS in young patients with mental disorders.

LAY SUMMARY: Although young patients with mental disorders did not show worse baseline characteristics in this nationwide study, mental disorders in young patients have deleterious effects on the incidence of both myocardial infarction (MI) and ischaemic stroke (IS) events, across depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorders, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder.

PMID:37156491 | DOI:10.1093/eurjpc/zwad102

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Clinical and genetic factors associated with post-operative nausea and vomiting after propofol anaesthesia

Acta Anaesthesiol Scand. 2023 May 8. doi: 10.1111/aas.14261. Online ahead of print.

ABSTRACT

BACKGROUND: The incidence of post-operative nausea and vomiting (PONV) remains at about 30% despite all therapeutic efforts to reduce it. The clinical risk factors guiding the prophylactic treatment are well established, but genetic factors associated with PONV remain poorly known. The aim of this study was to explore clinical and genetic factors impacting PONV by performing a genome-wide association study (GWAS) together with relevant clinical factors as covariates, and systematically attempt to replicate previously reported PONV associations. Relevant clinical factors are explored with logistic regression model.

METHODS: This was an observational case control study in Helsinki University Hospital between 1 August 2006 and 31 December 2010. One thousand consenting women with elevated risk for PONV, undergoing breast cancer surgery with standardised propofol anaesthesia and antiemetics. After exclusions for clinical reasons and failed genotyping, 815 patients were included with 187 PONV cases and 628 controls. Emergence of PONV up to 7th post-operative day was recorded. PONV at 2-24 h after surgery was selected to be the primary outcome. The GWAS explored associations between PONV and 653 034 genetic variants. Replication attempts included 31 variants in 16 genes.

RESULTS: The overall incidence of PONV up to 7th post-operative day was 35%, where 3% had PONV at 0-2 h and 23% at 2-24 h after surgery. Age, American Society of Anaesthesiologists status, the amount of oxycodone used in the post-anaesthesia care unit, smoking status, previous PONV, and history of motion sickness were statistically significant predictive factors in the logistic model. The receiver operating characteristic-area under the curve of 0.75 (95% CI 0.71-0.79) was calculated for the model. The GWAS identified six variants with suggestive association to PONV (p < 1 × 10-5 ). Of the previously reported variants, association with the DRD2 variant rs18004972 (TaqIA) was replicated (p = .028).

CONCLUSIONS: Our GWAS approach did not identify any high-impact PONV susceptibility variants. The results provide some support for a role of dopamine D2 receptors in PONV.

PMID:37156489 | DOI:10.1111/aas.14261

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Exogenous oxytocin administration during labor and autism spectrum disorder

Am J Obstet Gynecol MFM. 2023 May 6:101010. doi: 10.1016/j.ajogmf.2023.101010. Online ahead of print.

ABSTRACT

BACKGROUND: Oxytocin is a neuropeptide hormone that plays a key role in social behaviour, stress regulation, and mental health. Synthetic oxytocin administration is a common obstetrical practice, and importantly, previous research has suggested that intrapartum exposure may increase the risk of neurodevelopmental disorders, such as autism spectrum disorder (ASD).

OBJECTIVE: To examine the association between synthetic oxytocin exposure during labor and ASD diagnosis in the child.

STUDY DESIGN: This population-based retrospective cohort study compared two cohorts of children: 1) all children born in British Columbia (BC), Canada between April 1, 2000 and December 31, 2014 (n = 414,336 births), and 2) all children delivered at Soroka University Medical Center (SUMC) in Be’er Sheva, Israel between January 1, 2011 and December 31, 2019 (n = 82,892 births). Nine different exposure groups were examined. Cox proportional hazards models were used to estimate crude and adjusted hazard ratios of ASD in both cohorts based on induction and/or augmentation exposures status. To further control for confounding by indication, we conducted sensitivity analyses among a cohort of healthy, uncomplicated deliveries and among a group that was induced only for post-dates. Additionally, we stratified our analyses by infant sex to assess for potential sex differences.

RESULTS: In the BC cohort, 170,013 of 414,336 deliveries (41.0%) were not induced or augmented, 107,543 (26.0%) were exposed to oxytocin, and 136,780 (33.0%) were induced or augmented but not exposed to oxytocin. In the Israel cohort, 51,790 of 82,892 deliveries (62.5%) were not induced or augmented, 28,852 (34.8%) were exposed to oxytocin, and 2,250 (2.7%) were induced or augmented but not exposed to oxytocin. Upon adjusting for covariates in the main analysis, significant associations were observed in the Israel cohort, including adjusted hazard ratios (aHRs) of 1.51 (95% CI 1.20, 1.90) for oxytocin augmented births and 2.18 (95% CI 1.32, 3.57) for those induced by means other than oxytocin and not augmented. However, oxytocin induction was not significantly associated with ASD in the Israel cohort. In the Canadian cohort, there were no statistically significant aHRs. Further, no significant sex differences were observed in the fully adjusted models.

CONCLUSIONS: This study provides support that induction of labor through oxytocin administration does not increase the risk of ASD in the child. Our international comparison of two countries with differences in clinical practice regarding oxytocin administration for induction and/or augmentation suggests that previous studies reporting a significant association were likely confounded by the underlying indication for the induction.

PMID:37156463 | DOI:10.1016/j.ajogmf.2023.101010

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Comparing the effects of consuming almonds or biscuits on body weight in habitual snackers: A one-year randomized controlled trial

Am J Clin Nutr. 2023 May 6:S0002-9165(23)48908-3. doi: 10.1016/j.ajcnut.2023.05.015. Online ahead of print.

ABSTRACT

PURPOSE: Almonds are nutrient-rich, providing a healthier alternative to many snack foods. Studies report health benefits with regular almond consumption without adverse weight gain. However, most interventions have been relatively short or have included additional dietary advice. Taking a pragmatic approach, we compared consumption of almonds versus biscuits on body weight and other health outcomes in a population of regular snackers of discretionary foods, hypothesizing the almonds will displace some of the less healthful snacks in their current diets.

METHODS: We randomly assigned 136 non-obese habitual discretionary snack consumers to receive almonds or biscuits daily for one-year. These isocaloric snacks provided either 10% of participants’ total energy (TE) requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever was greater. Anthropometry, blood biomarkers, diet, appetite, sleep, and, physical activity, were assessed at baseline, 3, 6, and 12 months, and body composition and resting metabolic rate at baseline and 12 months.

RESULTS: The difference in changes for body weight from baseline to 12 months was not statistically significant (geometric means 67.1 kg and 69.5 kg for almonds and 66.3 kg and 66.3 kg for biscuits, P = 0.275). There were no statistically significant differences in changes for body composition or other non-dietary outcomes (all P ≥ 0.112). Absolute intakes of protein; total, polyunsaturated, and monosaturated fat; fibre; vitamin E; calcium; copper; magnesium; phosphorous; and zinc, and % TE from total monounsaturated, and polyunsaturated fat statistically significantly increased from baseline (all P ≤ 0.033), while % TE from carbohydrate and sugar statistically significantly (both P ≤ 0.014) decreased from baseline, in the almond compared to the biscuit group.

CONCLUSIONS: Almonds can be incorporated into the diets of habitual snackers to improve diet quality, without evidence for changes in body weight, compared to a popular discretionary snack food.

TRIAL REGISTRATION: ACTRN12618001758291 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375610&isReview=true.

PMID:37156442 | DOI:10.1016/j.ajcnut.2023.05.015

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Does CUD measure interhemispheric transfer time? The allocation of attention influences the Poffenberger effect

Neuropsychologia. 2023 May 6:108581. doi: 10.1016/j.neuropsychologia.2023.108581. Online ahead of print.

ABSTRACT

A simple reaction time (SRT) difference between responses to visual stimuli presented ipsilaterally and contralaterally to the responding hand, known as the Poffenberger effect or the crossed-uncrossed difference (CUD), has been commonly interpreted as a measure of interhemispheric transfer time (IHTT). However, the validity of this interpretation, and the measure’s reliability have been debated. The present study aimed at obtaining reliable evidence of the influence of spatial attention on the CUD, which would provide an argument against the classical structural interpretation of CUD. To meet the high statistical power requirements, over 100 thousand SRTs in total were collected from 12 participants. The task had three stimulus presentation conditions differing in the degree of stimulus location uncertainty: blocked (no uncertainty), randomized (full uncertainty), and mixed (25% uncertainty). The results showed robust effects of location uncertainty, proving spatial attention’s contribution to the CUD. Further, we observed a strong visual-field asymmetry reflecting the right hemisphere specialization in target detection and spatial reorienting. Lastly, despite exceptional reliability of the component SRT measures, the CUD reliability was still too low to justify using this measure as an index of individual differences.

PMID:37156411 | DOI:10.1016/j.neuropsychologia.2023.108581

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Anti-N SARS-CoV-2 assays for evaluation of natural viral infection

J Immunol Methods. 2023 May 6:113486. doi: 10.1016/j.jim.2023.113486. Online ahead of print.

ABSTRACT

BACKGROUND: The 2019 coronavirus (COVID-19) epidemic, required the development of different diagnostic tests. While reverse transcriptase real-time PCR (RT-PCR) remains the first-line test of choice in acute infection diagnosis, anti-N antibodies serological assays provide a valuable tool to differentiate natural SARS-CoV-2 immunological response from that induced by vaccination, thus the goal of our study was to evaluate three serological tests agreement for these antibodies detection.

METHODS: Three anti-N different tests were examined in 74 sera from patients referred or not COVID infection: immunochromatographic rapid test (Panbio™ COVID-19 IgG/IgM Rapid Test Device Abbott, Germany), ELISA kit (NovaLisa® SARS-CoV-2 IgG and IgM NovaTech Immunodiagnostic GmbH, Germany) and ECLIA immunoassay (Elecsys® Anti-SARS-CoV-2 Roche Diagnostics, Manheim, Germany).

RESULTS: Qualitative comparison of the three analytical methods revealed a moderate agreement between ECLIA immunoassay and immunochromatographic rapid test (Cohen kappa coefficient κ = 0.564). Correlation analysis indicated weak positive correlation between total Ig (IgT) detected by ECLIA immunoassay and IgG by ELISA test (p < 0.0001), the analysis of ECLIA IgT and IgM ELISA detected, showed no statistical correlation.

CONCLUSION: Comparison between of three analytical systems available for anti-N SARS-CoV-2 IgG and IgM antibodies showed a general agreement when compared to detect total and G class immunoglobulins, while doubtful or discordant results have been highlighted for IgT and IgM class. Anyway, all the tests examined provide reliable results to assess the serological status of SARS-CoV-2 infected patients.

PMID:37156408 | DOI:10.1016/j.jim.2023.113486

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Development of a protocol for objectively measuring digital device use in youth

Am J Prev Med. 2023 May 6:S0749-3797(23)00206-4. doi: 10.1016/j.amepre.2023.05.004. Online ahead of print.

ABSTRACT

INTRODUCTION: Screen time is predominantly measured using questionnaires assessing a limited range of activities. This project aimed to develop a coding protocol that reliably identified screen time, including device type and specific screen behaviours, from video camera footage.

METHODS: Screen use was captured from wearable and stationary PatrolEyes video cameras in 43 participants (10-14 years) within the home environment (May-December 2021, coding 2022, statistical analysis 2023). Following extensive piloting, the inter-rater reliability of the final protocol was determined in four coders using 600 minutes of footage from 18 participants who spent unstructured time on digital devices. Coders independently annotated all footage to determine 8 device types (e.g. phone, TV) and 9 screen activities (e.g. social media, video gaming) using Observer XT (behavioural coding software). Reliability was calculated using weighted Cohen’s Kappa (κ) for duration/sequence (meets criteria for total time in each category) and frequency/sequence (meets criteria for total time in each category and order of use) for every coder pair on a per-participant and footage type basis.

RESULTS: Overall reliability of the full protocol was excellent (≥ 0.8) for both duration/sequence (κ = 0.89-0.93) and the more conservative frequency/sequence (κ = 0.83-0.86) analyses. This protocol reliably differentiates between different device types (κ = 0.92-0.94) and screen behaviours (κ = 0.81-0.87). Coder agreement ranged from 91.7 to 98.8% across 28.6 to 107.3 different instances of screen use.

CONCLUSIONS: This protocol reliably codes screen activities in adolescents, offering promise for improving understanding of the impact of different screen activities on health.

PMID:37156402 | DOI:10.1016/j.amepre.2023.05.004

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Statistically sound comparison of standardized and simulation methods for oil spill source identification in real spill scenarios

Sci Total Environ. 2023 May 6:163930. doi: 10.1016/j.scitotenv.2023.163930. Online ahead of print.

ABSTRACT

The comparison of oil patterns of a spill (Sp) and suspected spill source (SS) samples is based on ratios between correlated GC-MS signals of oil-discriminating compounds, i.e., diagnostic ratios (DR). The Student’s t statistics (S-t) and a maximum relative difference (SC), proposed in standard methods, have been used for DR comparison due to their simplicity. An alternative methodology based on Monte Carlo Method (MCM) simulations of correlated signals, capable of accurately defining DR comparison criteria, proved that S-t and SC assumptions regarding DR normality and precision are frequently not valid, affecting comparison reliability. The performance of the approaches was accurately compared from independent signals of the same oil sample from a perfect match between Sp and SS. The present study describes the comparison of the approaches in real oil spill scenarios reproduced in International Round Robin Tests. Since as the number of compared DR increases, also rises the probability of not all equivalent DR being actually considered equivalent, the decision of oil pattern equivalence was based on two comparisons of independent sets of Sp and SS signals. The risk of true oil standard equivalency claims is compared for the three oil spill scenarios studied, which are different considering oil types, DR sets and spill weathering. The ability of the approaches to distinguish the Sp sample from an oil sample known not to be the source of the spill was also assessed. The MCM based on two independent DR comparison trials was the only one consistently producing fingerprint comparison risks of correct equivalence claims larger than 98 %. MCM also performed better in distinguishing different oil patterns. It was concluded that comparing >22 DR does not change the risk of correct oil pattern equivalence assessment significantly. The complexity of the MCM approach is overcome by using user-friendly and validated software.

PMID:37156391 | DOI:10.1016/j.scitotenv.2023.163930

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Investigating spatial distribution of fluoride in groundwater with respect to hydro-geochemical characteristics and associated probabilistic health risk in Baruipur block of West Bengal, India

Sci Total Environ. 2023 May 6:163877. doi: 10.1016/j.scitotenv.2023.163877. Online ahead of print.

ABSTRACT

Fluoride (F) enrichment in groundwater of the lower Gangetic plain in West Bengal, India is a major concern. Fluoride contamination and its toxicity were reported earlier in this region; however, limited evidence was available on the precise site of contamination, hydro-geochemical attributions of F mobilization and probabilistic health risk caused by fluoridated groundwater. The present study addresses the research gap by exploring the spatial distribution and physico-chemical parameters of fluoridated groundwater along with the depth-wise sedimental distribution of F. Approximately, 10 % of the groundwater samples (n = 824) exhibited high F ≥ 1.5 mg/l from 5, out of 19 gram-panchayats and Baruipur municipality area and the maximum F was observed in Dhapdhapi-II gram-panchayat with 43.7 % of samples showed ≥1.5 mg/l (n = 167). The distribution patterns of cations and anions in fluoridated groundwater were Na+ > Ca2+ > Mg2+ > Fe > K+ and Cl > HCO3 > SO42 > CO32 > NO3 > F. Different statistical models like Piper and Gibbs diagram, Chloro Alkaline plot, Saturation index were applied to better understand the hydro-geochemical characteristics for F leaching in groundwater. Fluoridated groundwater is of Na-Cl type which implies strong saline character. The intermediate zone between evaporation and rock dominance area controls F mobilization along with ion-exchange process occurring between groundwater and host silicate mineral. Furthermore, saturation index proves geogenic activities related to groundwater F mobilization. All cations present in sediment samples are closely interlinked with F in the depth range of 0-18.3 m. Mineralogical analyses revealed that muscovite is the most responsible mineral for F mobilization. The probabilistic health risk assessment disclosed severe health hazard in the order of infants > adults > children > teenagers through F tainted groundwater. At P95 percentile dose, all the studied age groups showed THQ >1 from Dhapdhapi-II gram-panchayat. Supply of F safe drinking water is required through reliable water supply strategies in the studied area.

PMID:37156382 | DOI:10.1016/j.scitotenv.2023.163877