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Nevin Manimala Statistics

Contributions of cerebral white matter hyperintensities, age, and pedal perception to postural sway in people living with HIV

AIDS. 2024 Mar 27. doi: 10.1097/QAD.0000000000003894. Online ahead of print.

ABSTRACT

OBJECTIVE: With aging, people living with HIV (PLWH) have diminishing postural stability that increases liability for falls. Factors and neuromechanisms contributing to instability are incompletely known. Brain white matter abnormalities seen as hyperintense (WMH) signals have been considered to underlie instability in normal aging and PLWH. We questioned whether sway-WMH relations endured after accounting for potentially relevant demographic, physiological, and HIV-related variables.

DESIGN: Mixed cross-sectional/longitudinal data acquired over 15 years in 141 PLWH and 102 age-range matched controls, 25-80 years old.

METHODS: Multimodal structural MRI data were quantified for 7 total and regional WMH volumes. Static posturography acquired with a force platform measured sway path length separately with eyes closed and eyes open. Statistical analyses used multiple regression with mixed modeling to test contributions from non-MRI and non-path data on sway path-WMH relations.

RESULTS: In simple correlations, longer sway paths were associated with larger WMH volumes in PWLH and controls. When demographic, physiological, and HIV-related variables were entered into multiple regressions, the sway-WMH relations under both vision conditions in the controls were attenuated when accounting for age and 2-point pedal discrimination. Although the sway-WMH relations in PLWH were influenced by age, 2-point pedal discrimination, and years with HIV infection, the sway-WMH relations endured for 5 of the 7 regions in the eyes-open condition.

CONCLUSIONS: The constellation of age-related increasing instability while standing, degradation of brain white matter integrity, and peripheral pedal neuropathy is indicative of advancing fraility and liability for falls as people age with HIV infection.

PMID:38537080 | DOI:10.1097/QAD.0000000000003894

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Nevin Manimala Statistics

Long-term cardiovascular risk reduction after gastric cancer surgery: a nationwide cohort study

Int J Surg. 2024 Apr 3. doi: 10.1097/JS9.0000000000001404. Online ahead of print.

ABSTRACT

BACKGROUND: Gastrectomy for gastric cancer is associated with postoperative changes in cardiovascular risk factors, however, the impact of gastrectomy on cardiovascular events remains unclear. We assessed the incidence of cardiovascular events between patients undergoing gastrectomy or endoscopic resection for gastric cancer, and the general population.

MATERIALS AND METHODS: This retrospective nationwide cohort study included patients with gastric cancer undergoing gastrectomy(n=37,698), endoscopic resection(n=2,773), and matched control population(n=161,887) between 2004 and 2013. We included patients without a history of cancer other than gastric cancer, myocardial infarction, or ischemic stroke. The primary outcome was the incidence of major adverse cardiovascular events (MACE) such as acute myocardial infarction, revascularization, or acute ischemic stroke, in patients with gastric cancer.

RESULTS: Among patients who underwent gastrectomy for gastric cancer, 2.9% (4.69 per 1000 person-years) developed novel MACE within the seven-year follow-up period. The gastrectomy group demonstrated a significantly decreased risk for MACE than the control population (hazard ratio[HR], 0.65; 95% confidence interval[CI], 0.61-0.69; P<0.001). Among the patients undergoing endoscopic resection for gastric cancer, 5.4% (8.21 per 1000 person-years) developed novel MACE within the seven-year follow-up period. The risk for MACE in the endoscopic resection group was not significantly different from the control population.

CONCLUSION: Patients with gastric cancer who have undergone gastrectomy exhibit a reduced risk of cardiovascular diseases in comparison to the general population. In contrast, the risk for cardiovascular diseases in patients with gastric cancer who underwent endoscopic resection did not demonstrate a significant difference in cardiovascular risk in comparison to the general population.

PMID:38537066 | DOI:10.1097/JS9.0000000000001404

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Nevin Manimala Statistics

A multicenter study of venetoclax-based treatment for patients with Richter transformation of chronic lymphocytic leukemia

Blood Adv. 2024 Mar 27:bloodadvances.2023012080. doi: 10.1182/bloodadvances.2023012080. Online ahead of print.

ABSTRACT

Patients with chronic lymphocytic leukemia (CLL) who develop Richter transformation (RT) have a poor prognosis when treated with chemoimmunotherapy regimens used for de novo diffuse large B-cell lymphoma. Venetoclax, a BCL2 inhibitor, has single agent efficacy in patients with RT and is potentially synergistic with chemoimmunotherapy. In this multicenter, retrospective study, we evaluated 62 patients with RT who received venetoclax-based treatment outside of a clinical trial, in combination with a Bruton tyrosine kinase inhibitor (BTKi; n=28), R-CHOP (n=13), or intensive chemoimmunotherapy other than R-CHOP (n=21). The best overall and complete response rates were 36%/25%, 54%/46%, and 52%/38%, respectively. The median progression-free and overall survival estimates for the same treatment groups were 4.9/14.3 months, 14.9 months/not reached, and 3.3/9 months, respectively. CLL with del(17p) was associated with a lower complete response rate in the total cohort (odds ratio [OR] 0.15; 95% confidence interval [CI] 0.04-0.6; p=0.01) and venetoclax-naïve subgroup (OR 0.13; 95%CI 0.02-0.66; p=0.01). TP53 mutated CLL was associated with a lower complete response rate (OR 0.15; 95%CI 0.03-0.74; p=0.02) and shorter progression-free survival (hazard ratio 3.1; 95%CI 1.21-7.95; p=0.02) only in venetoclax-naïve subgroup. No other clinical or baseline characteristics, including prior venetoclax treatment for CLL, showed statistically significant association with outcomes. Grade 3-4 neutropenia and thrombocytopenia events were most frequent with intensive chemoimmunotherapy + venetoclax; grade 3-4 infection rates were similar across treatment groups. In this difficult-to-treat RT patient population, venetoclax-based combination regimens achieved high response rates, with durable remission and survival observed in a subset of patients.

PMID:38537065 | DOI:10.1182/bloodadvances.2023012080

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Nevin Manimala Statistics

Examining the population level and individual level longitudinal stability of psychosocial measures in the US Army’s Global Assessment Tool (GAT)

Mil Psychol. 2021 Nov 22;34(2):197-210. doi: 10.1080/08995605.2021.1984741. eCollection 2022.

ABSTRACT

As a component of the US Army’s Comprehensive Soldier and Family Fitness program (CSF2), the Global Assessment Tool (GAT) represents a multidimensional constellation of measures designed to assess characteristics related to resilience. Using a foundation of validated measures from prior research, the GAT has been the vehicle for self-assessment to provide Soldiers, their families, and Army Civilians snapshots of their psychosocial wellness. Despite the long history of the measurement instrument (first implemented in 2009) and widespread use (mandatory for all active-duty Soldiers annually), the longitudinal capabilities of the GAT has received little attention. Here, we examine the longitudinal stability of the GAT across an approximate five-year time frame and multiple statistical approaches that demonstrate measurement stability at both the aggregate population level (people on average) and the individual level. We find evidence that the majority of the measures within the GAT are relatively stable over time both at the population level and individual level. This evidence contributes to knowledge of how best to improve the GAT for future use with the pay-off for the Army being a self-assessment tool that is more effective and efficient.

PMID:38536386 | PMC:PMC10161959 | DOI:10.1080/08995605.2021.1984741

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Nevin Manimala Statistics

Correction for range restriction: Lessons from 20 research scenarios

Mil Psychol. 2022 Mar 1;34(5):551-569. doi: 10.1080/08995605.2021.2022067. eCollection 2022.

ABSTRACT

Data are often available only for recruits, a range-restricted sample. This creates the potential for mistaken inferences and poor decisions. This is because inferences and decisions are about the population, not the sample. Despite these problems, researchers must try to determine statistical values as if the sample was not range-restricted. Although range restriction correction methods have been available for over a century, often they are not applied or are applied incorrectly. Technical psychometric discussions of range restriction have not improved researcher practice. As an alternative, realistic scenarios are presented to illustrate and explain the consequences of (1) failing to correct correlations, (2) using the wrong correction formula, (3) correcting when information about previous selection variables is unavailable, (4) using an inappropriate unrestricted sample, (5) incorrectly computing the confidence interval for corrected correlations, and (6) interpretation of results. Although there are situations under which correction has little effect, correction still provides better estimates of relations among variables. It also improves theoretical understanding and interpretation of real-world results.

PMID:38536384 | PMC:PMC10069334 | DOI:10.1080/08995605.2021.2022067

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Nevin Manimala Statistics

PTSD relapse in Veterans of Iraq and Afghanistan: A systematic review

Mil Psychol. 2020 Jun 4;32(4):300-312. doi: 10.1080/08995605.2020.1754123. eCollection 2020.

ABSTRACT

This systematic review examines studies published between 2003, the initial invasion of Iraq, and 2018 related to the long-term treatment outcomes for Veterans of Iraq and Afghanistan suffering from combat-related posttraumatic stress disorder (PTSD). More specifically this review attempts to estimate the rate at which Veterans experience the return of symptoms after completing treatment. The review was conducted by the authors in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The literature search identified eight eligible studies, which met the predefined inclusion criteria. Of the included studies a majority were deemed to be at a high risk of attrition bias. In addition, few studies comprehensively reported relevant relapse or recurrence related outcome statistics. The implications of the available evidence base on long-term treatment outcomes are discussed. Recommendations for future studies on relapse and recurrence of PTSD symptoms among Veterans of Iraq and Afghanistan are also presented.

PMID:38536379 | PMC:PMC10013559 | DOI:10.1080/08995605.2020.1754123

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Nevin Manimala Statistics

Interactions between childhood maltreatment and combat exposure trauma on stress-related activity within the cingulate cortex: a pilot study

Mil Psychol. 2020 Jan 31;32(2):176-185. doi: 10.1080/08995605.2019.1702831. eCollection 2020.

ABSTRACT

Childhood trauma may sensitize the brain, increasing vulnerability to maladaptive stress responses following adulthood trauma exposure. Previous work has identified the cingulum as a white matter pathway that may be sensitized to adulthood trauma by childhood maltreatment. In this pilot study of young adult male military veterans (N = 28), we examined a priori regions of interest (ROIs) connected by the cingulum, including regions involved in cognitive processes and stress responses. Our goal was to examine the interaction between childhood maltreatment and combat exposure on stress-related activity within cingulum-associated ROIs. As such we utilized a mild cognitive stress task, a performance-titrated multi-source interference task (MSIT). We found that childhood maltreatment moderated the effect of combat exposure on stress-related, interference-evoked activity within the dorsal anterior cingulate cortex (dACC, activation), subgenual ACC (sgACC, deactivation) and posterior midcingulate cortex (pMCC, deactivation). Greater combat exposure was associated with greater interference-evoked activation within the dACC, and less sgACC and pMCC deactivation among individuals with more severe childhood maltreatment. Our findings suggest that child maltreatment sensitizes these anterior and mid-cingulate regions to later life trauma. These findings may have implications for cognitive control, autonomic regulation/stress reactivity, and responses to noxious/aversive stimuli, which may contribute to increased psychiatric vulnerability.

PMID:38536373 | PMC:PMC10013548 | DOI:10.1080/08995605.2019.1702831

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Nevin Manimala Statistics

Participation in occupations, health and adjustment during the transition from military service: A cross-sectional study

Mil Psychol. 2021 Sep 24;33(5):320-331. doi: 10.1080/08995605.2021.1962180. eCollection 2021.

ABSTRACT

Participation in meaningful occupations is central to health, well-being, and adjustment during the transition from military service. The aim of the present study was to identify what occupations transitioning Australian Defence Force members participate in for the purpose of improving their health and well-being. A secondary aim was to identify if participation in various occupations was associated with better self-reported health and/or adjustment outcomes. One hundred and ninety-eight former Australian Defence Force members discharged on or after January 1, 2004 responded to a cross-sectional survey measuring adjustment, physical and mental health, and participation in occupations. Occupations were coded using the Time Use Classification system developed by the Australian Bureau of Statistics. An easier adjustment was reported by former service members who participated in employment-related activities, domestic activities, voluntary work and care activities, and social and community interaction (MD = -0.63 to -0.45, d = .37 to .52). Participation in employment-related activities, social and community interaction, and sport and outdoor activity was associated with better physical health (MD = 3.20 to 3.73, d = .34 to .40). Participation in employment-related activities was also associated with better mental health (MD = -3.75, d = .54). This research indicates that participation in occupation is a factor that may be utilized with former service members to positively influence health and adjustment during military transitions. Given differences in participation and outcomes among different sub-groups, it is recommended that occupation-based programs be tailored to individual preferences and transition needs.

PMID:38536366 | PMC:PMC10013534 | DOI:10.1080/08995605.2021.1962180

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Nevin Manimala Statistics

Use of electronic cigarettes in the United States service member and Veteran populations: A narrative review (2019)

Mil Psychol. 2021 Apr 13;33(3):169-181. doi: 10.1080/08995605.2021.1897493. eCollection 2021.

ABSTRACT

Electronic Nicotine Delivery Systems (ENDS) are an increasingly popular form of a nicotine delivery device, particularly among young adults and adolescents. The health consequences of long-term ENDS use are not known. Two populations that warrant special consideration are members of the United States Military (service members) and US Veterans. In this narrative review of literature before December 2019, research on ENDS use in these two populations is described in relation to four themes relevant to ENDS use: Prevalence of ENDS use; perceptions of ENDS; correlates of ENDS use; and use of ENDS for smoking cessation. This narrative review summarized research findings in each of these four areas and identified areas for future research.

PMID:38536356 | PMC:PMC10013515 | DOI:10.1080/08995605.2021.1897493

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Nevin Manimala Statistics

Investigating the latent dimensions of posttraumatic stress disorder and the role of anxiety sensitivity in combat-exposed Filipino soldiers

Mil Psychol. 2020 Apr 3;32(3):223-236. doi: 10.1080/08995605.2020.1724594. eCollection 2020.

ABSTRACT

Identifying the optimal factor structure of posttraumatic stress disorder (PTSD) has recently been reinvigorated in literature due to the substantial changes to its diagnostic criteria in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Currently, six models of PTSD are supported in literature, but there is no consensus on the best-fitting factor structure. Additionally, the extant literature examining the relationship between PTSD symptom-grouping and AS in the latent level has been scarce. The present study’s objectives are two-fold: first, we aimed to identify the best-fitted model of PTSD by comparing the six empirically-supported models, and; second, we examined the relationship between the best-fitting model with anxiety sensitivity (AS). Utilizing a sample of 476 combat-exposed soldiers, the results suggest that both the anhedonia and hybrid models provide the best fit to the data, with the anhedonia model achieving slightly better fit indices. Further, the examination on the influence of AS to PTSD reveal that while there is a pattern of decreasing factor loadings and factor correlations when accounting for AS, the changes are not significant to alter the PTSD symptom-structure. Based on these results, our findings suggest further investigation on the possible mediating or moderating mechanisms by which AS may influence PTSD.

PMID:38536310 | PMC:PMC10013399 | DOI:10.1080/08995605.2020.1724594