Tag: pubmed

Addict Behav. 2021 Mar 26;120:106936. doi: 10.1016/j.addbeh.2021.106936. Online ahead of print.

ABSTRACT

BACKGROUND: Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood.

PURPOSE: This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder.

METHODS: Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale.

RESULTS: Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51).

LIMITATIONS: Meta-analysis options were limited by the variety of study designs.

CONCLUSIONS: Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design. Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders. Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).

PMID:33975176 | DOI:10.1016/j.addbeh.2021.106936

J Forensic Leg Med. 2021 May 6;80:102176. doi: 10.1016/j.jflm.2021.102176. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the difference in selected variables between children with and without hymenal transection, which is a healed defect that extends through the entire depth of the posterior hymenal membrane to the vaginal wall.

MATERIALS AND METHODS: All female children from Southern Denmark who were examined by photocolposcopy in a six-year period were included in a retrospective cohort study. Statistical analyses included a chi-square test and a logistic regression analysis.

RESULTS: Eighty girls under 15 years of age who were suspected to have been sexually abused were included. Sixteen of the girls had hymenal transections. There was a statistically significant correlation between the presence of hymenal transections and reported fresh bleeding after the assault.

CONCLUSION: Bleeding after an assault could indicate more severe lesions, which might explain why these patients did not heal completely.

PMID:33975177 | DOI:10.1016/j.jflm.2021.102176

Neurobiol Aging. 2021 Apr 11;104:71-81. doi: 10.1016/j.neurobiolaging.2021.03.017. Online ahead of print.

ABSTRACT

Aging is associated with a gradual decline in the sensory systems and noisier sensory information. Some research has found that older adults compensate for this with enhanced multisensory integration. However, less is known about how aging influences visual-vestibular integration, an ability that underlies self-motion perception. We examined how visual-vestibular integration changes in participants from across the lifespan (18-79 years old) with a simple reaction time task. Participants were instructed to respond to visual (optic flow) and vestibular (inertial motion) acceleration cues, presented either alone or at a stimulus onset asynchrony. We measured reaction times and computed the violation area relative to the race model inequality as a measure of visual-vestibular integration. Across all ages, the greatest visual-vestibular integration occurred when the vestibular cue was presented first. Age was associated with longer reaction times and a significantly lower detection rate in the vestibular-only condition, a finding that is consistent with an age-related increase in vestibular noise. Although the relationship between age and visual-vestibular integration was positive, the effect size was very small and did not reach statistical significance. Our results suggest that although age is associated with a significant increase in vestibular perceptual threshold, the relative amount of visual-vestibular integration remains largely intact.

PMID:33975121 | DOI:10.1016/j.neurobiolaging.2021.03.017

Cognition. 2021 May 8;214:104754. doi: 10.1016/j.cognition.2021.104754. Online ahead of print.

ABSTRACT

Over the past few decades, several lines of research have investigated how information is distributed in language. In particular, research has suggested that speakers distribute the information in linguistic utterances as evenly as possible, in order to make the utterance more robust against noise for the hearer. Several studies have provided evidence for this hypothesis in limited linguistic domains, showing that speakers manipulate acoustic and syntactic features by using redundancy to avoid drastic spikes or troughs in information content. However, this previous work doesn’t consider information density across entire utterances, and only rarely has the proposed function of noise resistance been directly explored in detail. Here, we introduce a new descriptive statistic (DORM) that quantifies the uniformity of information across an entire utterance. We present this alongside an algorithm (UIDO) that allows us to quantify the contribution made to an utterance’s uniformity by the order of its elements, independent of its level of redundancy. Using a simple simulation with data from an English corpus, we show that utterances whose order results in more uniform distributions of information are, in fact, more robust against noise.

PMID:33975125 | DOI:10.1016/j.cognition.2021.104754

Am J Emerg Med. 2021 May 6;48:203-208. doi: 10.1016/j.ajem.2021.05.007. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of early vasopressin initiation on clinical outcomes in patients with septic shock is uncertain. A systematic review and meta-analysis was performed to evaluate the impact of early start of vasopressin support within 6 h after the diagnosis on clinical outcomes in septic shock patients.

METHODS: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials (RCTs) and cohort studies from inception to the 1st of February 2021. We included studies involving adult patients (> 16 years)with septic shock. All authors reported our primary outcome of short-term mortality and in the experimental group patients in the studies receiving vasopressin infusion within 6 h after diagnosis of septic shock and in the control group patients in the studies receiving no vasopressin infusion or vasopressin infusion 6 h after diagnosis of septic shock, clearly comparing with clinically relevant secondary outcomes(use of renal replacement therapy(RRT),new onset arrhythmias, ICU length of stay and length of hospitalization). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).

RESULTS: Five studies including 788 patients were included. The primary outcome of this meta-analysis showed that short-term mortality between the two groups was no difference (odds ratio [OR] = 1.09; 95% CI, 0.8 to 1.48; P = 0.6; χ2 = 0.83; I2 = 0%). Secondary outcomes demonstrated that the use of RRT was less in the experimental group than that of the control group (OR = 0.63; 95% CI, 0.44 to 0.88; P = 0.007; χ2 = 3.15; I2 = 36%).The new onset arrhythmias between the two groups was no statistically significant difference (OR = 0.59; 95% CI, 0.31 to 1.1; P = 0.10; χ2 = 4.7; I2 = 36%). There was no statistically significant difference in the ICU length of stay(mean difference = 0.16; 95% CI, – 0.91 to 1.22; P = 0.77; χ2 = 6.08; I2 = 34%) and length of hospitalization (mean difference = -2.41; 95% CI, -6.61 to 1.78; P = 0.26; χ2 = 8.57; I2 = 53%) between the two groups.

CONCLUSIONS: Early initiation of vasopressin in patients within 6 h of septic shock onset was not associated with decreased short-term mortality, new onset arrhythmias, shorter ICU length of stay and length of hospitalization, but can reduce the use of RRT. Further large-scale RCTs are still needed to evaluate the benefit of starting vasopressin in the early phase of septic shock.

PMID:33975132 | DOI:10.1016/j.ajem.2021.05.007

Ear Hear. 2021 Apr 8. doi: 10.1097/AUD.0000000000001048. Online ahead of print.

ABSTRACT

OBJECTIVES: Speech understanding in noise is difficult for patients with a cochlear implant. One common and disruptive type of noise is transient noise. We have tested transient noise reduction (TNR) algorithms in cochlear implant users to investigate the merits of personalizing the noise reduction settings based on a subject’s own preference.

DESIGN: The effect of personalizing two parameters of a broadband and a multiband TNR algorithm (TNRbb and TNRmb, respectively) on speech recognition was tested in a group of 15 unilaterally implanted subjects in cafeteria noise. The noise consisted of a combination of clattering dishes and babble noise. Each participant could individually vary two parameters, namely the scaling factor of the attenuation and the release time (τ). The parameter τ represents the duration of the attenuation applied after a transient is detected. As a reference, the current clinical standard TNR “SoundRelax” from Advanced Bionics was tested (TNRbb-std). Effectiveness of the algorithms on speech recognition was evaluated adaptively by determining the speech reception threshold (SRT). Possible subjective benefits of the algorithms were assessed using a rating task at a fixed signal-to-noise ratio (SNR) of SRT + 3 dB. Rating was performed on four items, namely speech intelligibility, speech naturalness, listening effort, and annoyance of the noise. Word correct scores were determined at these fixed speech levels as well.

RESULTS: The personalized TNRmb improved the SRT statistically significantly with 1.3 dB, while the personalized TNRbb degraded it significantly by 1.7 dB. For TNRmb, we attempted to further optimize its settings by determining a group-based setting, leaving out those subjects that did not experience a benefit from it. Using these group-based settings, however, TNRmb did not have a significant effect on the SRT any longer. TNRbb-std did not affect speech recognition significantly. No significant effects on subjective ratings were found for any of the items investigated. In addition, at a constant speech level of SRT + 3 dB, no effect of any of the algorithms was found on word correct scores, including TNRmb with personalized settings.

CONCLUSIONS: Our study results indicate that personalizing noise reduction settings of a multiband TNR algorithm can significantly improve speech intelligibility in transient noise, but only under challenging listening conditions around the SRT. At more favorable SNRs (SRT + 3 dB), this benefit was lost. We hypothesize that TNRmb was beneficial at lower SNRs, because of more effective artifact detection under those conditions. Group-averaged settings of the multiband algorithm did not significantly affect speech recognition. TNRbb decreased speech recognition significantly using personalized parameter settings. Rating scores were not significantly affected by the algorithms under any condition tested. The currently available TNR algorithm for Advanced Bionics systems (SoundRelax) is a broadband filter that does not support personalization of its settings. Future iterations of this algorithm might benefit from upgrading it to a multiband variant with the option to personalize its parameter settings.

PMID:33974780 | DOI:10.1097/AUD.0000000000001048

Ear Hear. 2021 Jan 11. doi: 10.1097/AUD.0000000000000976. Online ahead of print.

ABSTRACT

OBJECTIVES: Otoacoustic emissions, a byproduct of active cochlear mechanisms, exhibit a higher magnitude in females than in males. The relatively higher levels of androgen exposure in the male fetus are thought to cause this difference. Postnatally, the onset of puberty is also associated with the androgen surge in males. In this study, we investigated sexual dimorphism in age-related changes in stimulus-frequency otoacoustic emissions for children.

DESIGN: In a retrospective design, stimulus-frequency otoacoustic emissions were analyzed from a cross-sectional sample of 170 normal-hearing children (4 to 12 years) and 67 young adults. Wideband acoustic immittance and efferent inhibition measures were analyzed to determine the extent to which middle ear transmission and efferent inhibition can account for potential sex differences in stimulus-frequency otoacoustic emissions.

RESULTS: Male children showed a significant reduction in otoacoustic emission magnitudes with age, whereas female children did not show any such changes. Females showed higher stimulus-frequency otoacoustic emission magnitudes compared with males. However, the effect size of sex differences in young adults was larger compared with children. Unlike the otoacoustic emission magnitude, the noise floor did not show sexual dimorphism; however, it decreased with age. Neither the wideband absorbance nor efferent inhibition could account for the sex differences in stimulus-frequency otoacoustic emissions.

CONCLUSIONS: The cochlear-amplifier function remains robust in female children but diminishes in male children between 4 and 12 years of age. We carefully eliminated lifestyle, middle ear, and efferent factors to conclude that the androgen surge associated with puberty likely caused the observed masculinization of stimulus-frequency otoacoustic emissions in male children. These findings have significant theoretical consequences. The cochlea is considered mature at birth; however, the present findings highlight that functional cochlear maturation, as revealed by otoacoustic emissions, can be postnatally influenced by endogenous hormonal factors, at least in male children. Overall, work reported here demonstrates sexual dimorphism in the functional cochlear maturational processes during childhood.

PMID:33974790 | DOI:10.1097/AUD.0000000000000976

Ear Hear. 2020 Dec 16. doi: 10.1097/AUD.0000000000000974. Online ahead of print.

ABSTRACT

OBJECTIVES: Military Service members and Veterans commonly report hearing loss and tinnitus, both of which can result in significant disability. During military service, Service members are exposed to many different types of loud noise, which is strongly associated with hearing loss and tinnitus. Other military-related exposures, such as chemicals and traumatic brain injury (TBI), are also linked with auditory problems. The purpose of the “Noise Outcomes in Servicemembers Epidemiology” (NOISE) study is to gather information from Active-Duty Service members and recently separated Veterans about their military and nonmilitary noise exposures, other relevant military and nonmilitary exposures, and potential outcomes of these exposures including tinnitus, hearing loss, and other hearing-related health concerns.

DESIGN: The NOISE study assesses lifetime noise exposures, chemical and blast exposures, TBI, physical and psychiatric comorbidities, and other military and nonmilitary exposures and outcomes that can affect auditory function. Participants undergo comprehensive in-person audiologic examinations; those who experience tinnitus undergo a complete tinnitus assessment. Exposures and select outcomes are reassessed annually by mail, and the comprehensive in-person assessment is completed every 5 years. This report presents descriptive, baseline data obtained from the first 690 participants enrolled between 2014 and 2018.

RESULTS: Some notable findings from this analysis include: (1) the prevalence of hearing loss in the sample was 8% for low frequencies (0.25 to 2 kHz), 20% for high frequencies (3 to 8 kHz), and 39% for extended high frequencies (9 to 16 kHz); (2) the prevalence of tinnitus was 53%; (3) the prevalence of both hearing loss and tinnitus was higher among those with higher age, more years of military service, greater degree of noise exposure, and exposures to blasts and/or TBI in the military; and (4) tinnitus was most prevalent among participants who serve/served in the Army relative to the other military branches.

CONCLUSIONS: The NOISE study is acquiring comprehensive data on military-related auditory dysfunction. It is the first of its kind to enroll active Service members and recently separated Veterans into a longitudinal study to examine the etiology and outcomes of tinnitus and hearing loss in this population. Although these data do not necessarily represent the entire military and Veteran populations, ongoing enrollment is focused on increasing generalizability and will also provide the statistical power to conduct multivariable analyses. This will allow us to examine longitudinal associations of interest while controlling for potential confounders and other possible sources of error. These data will provide critical knowledge to refine future military hearing conservation efforts and inform efforts to develop future treatments.

PMID:33974792 | DOI:10.1097/AUD.0000000000000974

WMJ. 2021 Apr;120(1):17-22.

ABSTRACT

BACKGROUND: Studies suggest widespread advantages to peer mentoring programs; however, there is minimal data pertaining to medical students mentoring undergraduate students.

OBJECTIVES: To determine the feasibility and perceived effectiveness of a medical student-undergraduate student peer mentorship program.

METHODS: A needs assessment guided the development of Pre-Med Pair Up, a program connecting medical student mentors from the Medical College of Wisconsin and other US medical schools to undergraduates at Marquette University and the University of Wisconsin-Oshkosh to provide peer mentorship, premedical resources, and global health information. After 6 months, surveys were distributed to 43 premedical and 26 medical students to evaluate the program. Descriptive statistics and Pearson correlations (r) were used to assess the relational strength between program components and student confidence and knowledge.

RESULTS: Eleven undergraduate and 26 medical students completed surveys. Most undergraduates expressed increased confidence in abilities as premedical students associated with program involvement (18.2% great, 27.3% moderate, 45.5% minimal, 9.1% no improvement). Increased confidence was strongly correlated with knowledge of volunteer opportunities (r = 0.887, P < 0.001) and feelings of preparedness for the medical school application process (r = 0.854, P = 0.001) and curriculum (r = 0.871, P < 0.001).

CONCLUSION: While self-reported confidence improved and overall positive program outcomes were statistically significant, the number of participants was low and the number who completed mid-year surveys was even lower. Therefore, no conclusions about program effectiveness were made. Instead, a lessons-learned approach was used to discuss the pilot development, implementation, and suggestions for future program installment.

PMID:33974760

WMJ. 2021 Apr;120(1):34-40.

ABSTRACT

PROBLEM CONSIDERED: Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy.

METHODS: Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic’s first 19 months.

RESULTS: Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant increase in the number of diagnostic sleep apnea tests performed (average 22.4 tests per year pre-intervention, 77 per year post-intervention [P = 0.0012]).

DISCUSSION AND CONCLUSIONS: Despite a streamlined referral pipeline, completion rates of OSA testing in pregnant women remained below 50%. However, the overall number of women referred and who completed testing increased significantly during this time period. Of those who completed testing, the majority were diagnosed with OSA. Since starting this clinic, we have created resources to familiarize patients with the equipment and worked to reduce other barriers. Assessment of these interventions and the impact of treatment on obstetric outcomes is ongoing, as is assessment of reasons women do not complete diagnostic testing.

PMID:33974763