Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration

Pediatric SARS-CoV-2 infection and development of anxiety and depression

Objective

It remains unclear whether emerging mental health concerns in children infected with SARS-CoV-2 are a direct result of the infection or due to the indirect effects of the pandemic. Therefore, we sought to assess the frequency of new diagnoses of anxiety and/or depression among children diagnosed with and without SARS-CoV-2 infection who were tested in pediatric emergency departments.

Methods

A prospective cohort study with 6- and 12-month follow-ups was conducted across 14 Canadian tertiary-care pediatric emergency departments of the Pediatric Emergency Research Canada (PERC) network. The study included children aged <18 years who were tested for SARS-CoV-2 infection between August 2020 and February 2022. The primary outcome was the diagnosis of anxiety and/or depression reported during follow-up. The surveys incorporated a modified version of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) Long-COVID Pediatric Questionnaire.

Results

Among the participants who were eligible for 6- and 12-month follow-ups, 64.7% (268/414) of SARS-CoV-2-positive and 71.9% (743/1,033) of SARS-CoV-2-negative participants completed follow-up at these time points, respectively. The median age was 7.0 [inter-quartile range (IQR): 5.0-11.0] years, and 54.2% (548/1,011) were male. New diagnoses of anxiety and/or depression reported on either survey did not differ significantly between test-positive (4.1%, 11/268) and test-negative (2.8%; 21/743) participants [difference = 1.3% (95% CI: -1.3 to 4.2)]. There was a higher prevalence of new diagnoses of anxiety and/or depression among SARS-CoV-2-negative participants aged ≥12 years relative to those aged <12 years [8.7% (13/149) vs. 1.3% (8/594); difference = 7.4%; 95% CI of the difference = 3.0-12.5], but not among SARS-CoV-2-positive participants [4.4% (2/45) vs. 4.0% (9/223); difference = 0.4%; 95% CI of the difference = -5.6 to 9.4]. At 6 or 12 months, SARS-CoV-2-positive participants were more likely to experience confusion and/or lack of concentration, abdominal pain, and insomnia.

Conclusions

Although no association was found between SARS-CoV-2 infection and new diagnoses of anxiety and/or depression, SARS-CoV-2-positive participants were more likely to experience confusion/lack of concentration, abdominal pain, and insomnia. This finding, in the context of an increased prevalence of new diagnoses of anxiety and depression, underscores the impacts of societal changes on the mental health of children. Our finding that some non-specific symptoms were more frequently reported by SARS-CoV-2-positive participants emphasizes the need for further investigation of the underlying pathophysiologic mechanisms.

The relationship between cardiorespiratory fitness and firefighter occupational performance: a systematic review and meta-analysis examining absolute versus relative VO2max

Unequivocally greater cardiorespiratory fitness (CRF) is beneficial for performing firefighting occupational tasks (OTs); however, the contribution of absolute vs. relative VO2max with OT performance warrants further study. This systematic review and meta-analysis compared the relationship between relative and absolute VO2max with the performance of firefighting OTs. Studies included career, volunteer, and firefighter recruits and examined the association of CRF measures with OT performance. Thirty-two studies were identified with 19 studies incorporating an occupational circuit of simulated firefighting OTs such as stair climbing, carrying equipment, victim rescue, forcible entry, and search tasks. The relative and absolute VO2max pooled correlations were r̅ =-0.64 (95%CI: [-0.69,-0.58]) and r̅ = -0.75 (95%CI: [-0.88, -0.62]), respectively. The findings support the importance of CRF, particularly absolute VO2max, for effective performance of firefighting OTs. Absolute VO2max likely has a stronger relationship with firefighters' functional work rate during operations, reflecting the absolute demands of firefighting tasks.

Cancer awareness among adolescents in Irish schools: A cross-sectional study

PURPOSE

The aim of this study was to assess adolescents' awareness of cancer signs and symptoms, cancer risk factors, cancer screening programmes, and perceived barriers to seeking medical advice.

METHODS

A cross-sectional survey was conducted using an adapted version of the adolescent cancer awareness tool which was originally modified from the Cancer Awareness Measure (CAM) (Version 2.1). The sample included 474 adolescents aged 15 to 18 years recruited from nine Irish schools between November 2021 and May 2022.

RESULTS

Awareness of cancer warning signs and symptoms was low when open-ended (recall) questions were used and relatively high for closed (recognition) questions. Unexplained lump or swelling was the most frequently identified cancer symptom. The least reported were difficulty swallowing and a sore that does not heal. Smoking was the most reported cancer risk factor. The least reported were not eating enough fruit and vegetables, a diet high in fat, and infection with viruses. Generally, females had greater awareness than males. The greatest barrier to seeking help was "worry about what the doctor might find" and the least reported barrier was "I don't feel respected by the doctor."

CONCLUSIONS

Overall recognition of symptoms or risk factors of cancer was higher than recall. Several modifiable barriers to medical help-seeking were identified. Findings from this study suggest further exploration using a qualitative approach to investigate the factors influencing adolescents' cancer awareness and barriers to help-seeking.

Evaluating Poison Control Center Telemedicine Support for Health Care Facilities in Managing Overdose and Suicide During COVID-19

Background: We aimed to assess differences in the impact of the COVID-19 public health emergency (PHE) on urban and rural health care facility (HCF) management of intentional overdoses and self-harm using telemedicine consultation from poison control centers (PCCs). Methods: We utilized a mixed-methods, explanatory study design of poison centers in the United States. The primary exposures were geography (urban vs. rural HCFs) and time (the pre-COVID-19 PHE [January 1, 2018-March 10, 2020] vs. COVID-19 PHE [March 11, 2020-December 31, 2022]). The primary outcomes were patient disposition: admission to critical care unit (CCU); non-CCU; or psychiatric facility. We measured these associations using a multinomial regression, adjusting for demographic and clinical factors. We interviewed PCC staff to gain insight about perspectives of PCC staff in managing intentional overdoses. Results: Of the 1,416,809 intentional overdoses identified, 1,313,704 (93%) were included in our analysis. Compared with urban HCFs in the pre-COVID-19 era, CCU admissions were greater among rural HCFs (adjusted odds ratio [aOR]: 1.12; 95% confidence interval [CI]: 1.10-1.14); however, they were lower in the COVID-19 PHE era within rural (aOR: 0.72; 95% CI: 0.71-0.73) and urban HCFs (aOR: 0.74; 95% CI: 0.73-0.75). Trends were similar in non-CCU and psychiatric admissions. We identified four themes: challenges of admitting overdose cases; changes in calls related to COVID-19 and intentional overdoses; changes in technology, staffing, and operations to adapt to the COVID-19 PHE; and changes in communications for telemedicine. Conclusions: The COVID-19 PHE introduced challenges for urban and rural HCFs in treating mental health and overdoses. PCCs are a vital source of telemedicine support available to both urban and rural clinical providers to ease the existing health care burden.

The relationship between below average cognitive ability at age 5 years and the child's experience of school at age 9

Background

At age 5, while only embarking on their educational journey, substantial differences in children's cognitive ability will already exist. The aim of this study was to examine the causal association between below average cognitive ability at age 5 years and child-reported experience of school and self-concept, and teacher-reported class engagement and emotional-behavioural function at age 9 years.

Methods

This longitudinal cohort study used data from 7,392 children in the Growing Up in Ireland Infant Cohort, who had completed the Picture Similarities and Naming Vocabulary subtests of the British Abilities Scales at age 5. Principal components analysis was used to produce a composite general cognitive ability score for each child. Children with a general cognitive ability score more than 1 standard deviation (SD) below the mean at age 5 were categorised as 'Below Average Cognitive Ability' (BACA), and those scoring above this as 'Typical Cognitive Development' (TCD). The outcomes of interest, measured at age 9, were child-reported experience of school, child's self-concept, teacher-reported class engagement, and teacher-reported emotional behavioural function. Binary and multinomial logistic regression models were used to examine the association between BACA and these outcomes.

Results

Compared to those with TCD, those with BACA had significantly higher odds of never liking school [Adjusted odds ratio (AOR) 1.82, 95% CI 1.37-2.43, p < 0.001], of being picked on (AOR 1.27, 95% CI 1.09-1.48) and of picking on others (AOR 1.53, 95% CI 1.27-1.84). They had significantly higher odds of experiencing low self-concept (AOR 1.20, 95% CI 1.02-1.42) and emotional-behavioural difficulties (AOR 1.34, 95% CI 1.10-1.63, p = 0.003). Compared to those with TCD, children with BACA had significantly higher odds of hardly ever or never being interested, motivated and excited to learn (AOR 2.29, 95% CI 1.70-3.10).

Conclusion

Children with BACA at school-entry had significantly higher odds of reporting a negative school experience and low self-concept at age 9. They had significantly higher odds of having teacher-reported poor class engagement and problematic emotional-behavioural function at age 9. The findings of this study suggest BACA has a causal role in these adverse outcomes. Early childhood policy and intervention design should be cognisant of the important role of cognitive ability in school and childhood outcomes.

Trends and outcomes of heart failure hospitalizations during COVID-19 pandemic

BACKGROUND

COVID-19 has affected many hospitalizations. In this study, we intended to understand the effects of COVID-19 pandemic on heart failure hospitalizations in the state of California.

METHOD

This study was a retrospective analysis of California State Inpatient Database during March to December of 2019 and 2020. Adult hospitalizations with heart failure were included for the analysis. Main outcome variables were in-hospital mortality, mechanical ventilation, mechanical circulatory support, vasopressor use, and acute respiratory distress syndrome (ARDS).

RESULTS

There were 450,771 (53.7%) heart failure hospitalizations during March to December of 2019, compared to 388,795 (46.3%) during March to December of 2020 (relative decrease, 13.7%). Heart failure hospitalization rates were lower during 2020, compared to 2019. Comparison of adverse hospital outcomes across the two-time frames showed that in-hospital mortality (2.9% versus 2.7%, P = 0.003), mechanical circulatory support (0.7% versus 0.5%. P < 0.001), vasopressor use (1.3% versus 1.0%, P < 0.001), and ARDS (0.1% versus 0.06%, P = 0.007) were significantly higher among hospitalizations in 2020. Regression analysis showed that the odds of in-hospital mortality (OR, 1.09; 95% CI, 1.06-1.11), mechanical ventilation (OR, 1.07; 95% CI, 1.05-1.09), vasopressor use (OR, 1.07; 95% CI, 1.04-1.10), and ARDS (OR, 1.74; 95% CI, 1.58-1.91) were significantly higher among heart failure hospitalizations in 2020.

CONCLUSIONS

Our study found that patients with heart failure hospitalized during the COVID-19 pandemic had greater in-hospital adverse events such as greater in-hospital mortality, mechanical ventilation use, vasopressor use, and ARDS. These findings warrant that heart failure required prompt hospitalization and treatment irrespective of restrictive mandates during COVID-19 pandemic.

Robotic- assisted minimally invasive Ivor-Lewis handsewn anastomosis technique and outcomes from a large-volume European centre

In minimally invasive transthoracic esophagectomy, intrathoracic anastomoses are usually performed with stapling devices to avoid a technically challenging handsewn technique in the upper mediastinum. Few have published about handsewn anastomotic techniques due to the technically demanding requirements for suturing with rigid instruments in the thoracic cavity. With robot-assisted minimally invasive esophagectomy (RAMIE), the robot provides increased dexterity, enabling construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of our technique for hand-sewn intrathoracic anastomosis in RAMIE, following the initial learning phase between 2016 and 2018 in UMC Utrecht. Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis were included in this retrospective study. Data were extracted from a prospectively maintained institutional database. Key technique steps included esophageal stay-sutures, use of barbed sutures for the anastomosis, placement of tension-releasing stitches, and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage; secondary outcomes included anastomotic stricture rate and duration of anastomosis construction. Between 1 November 2019 and 30 May 2023, 89 consecutive patients were included. Anastomotic leakage (defined by the Esophageal Complications Consensus Group) occurred in 11 patients (12.4%), which involved a grade I leak in four patients (4.5%), grade II leak in one patient (1.1%), and grade III leakage in six patients (6.7%). The median duration of anastomosis creation was 33 minutes (range, 23-55 minutes). Stricture rate was 32.6% (29 patients) at 1 year post-operatively for which dilation was needed for all patients. This study shows that a robot-assisted hand-sewn intrathoracic anastomosis in RAMIE is feasible, safe, and reliable.

Safety and efficacy of fixed-dose combination of dapagliflozin and saxagliptin in patients with type 2 diabetes mellitus - a phase 4 study in India

Objective

To determine the post-marketing safety profile of a once-daily fixed-dose combination (FDC) of dapagliflozin (10 mg) and saxagliptin (5 mg) given orally for 24 weeks or until discontinuation, in Indian patients with type 2 diabetes mellitus (T2DM) who are on stable dose of metformin.

Design

Prospective, single-arm, multicenter study.

Setting

Adult patients with T2DM enrolled from April 2021 to March 2023 across 9 study sites in India.

Outcome measures

The primary objective was to determine the adverse event (AE) profile of the FDC. Additionally, we assessed changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), systolic blood pressure, and body weight at 24 weeks, compared to baseline.

Results

Of the 196 patients (median age [range]: 53 [20 to 78] years) analyzed, 61.2% were males with mean ± standard deviation [SD] duration of T2DM of 7.1 ± 5.7 years. Overall, 111 (56.6%) presented with ≥1 comorbidity; the most frequent being hypertension (57; 29.1%). At 24 weeks, a total of 22 patients (11.2%) experienced 40 AEs; the majority of them had mild AEs. The most frequent AEs included urinary tract infection (5; 2.6%), pyrexia (5; 2.6%), nasopharyngitis (3; 1.5%), and balanoposthitis (3; 1.5%). The AEs of special interest reported were genital tract infection (3; 1.5%) and hypoglycemia (1; 0.5%). No serious AEs were reported. None of the AEs required treatment discontinuation. Three (1.5%) patients had AEs leading to temporary interruption of the study drug. No deaths were reported in this study. The mean absolute change in HbA1c (1.2% ± 1.1%), FPG (24.4 ± 62.9 mg/dL), and weight (2.1 ± 4.0 kg) from baseline to 24 weeks was statistically significant (p < 0.0001).

Conclusion

Our study demonstrated the safety and efficacy of once-daily FDC of dapagliflozin and saxagliptin when added to metformin in Indian patients with T2DM.

Complex Sepsis Presentations, SEP-1 Compliance, and Outcomes

Importance

The Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Management Bundle (SEP-1) is supported by observational studies that report SEP-1 compliance is associated with lower mortality. Most studies, however, adjusted for limited confounders and provided little insight into why bundle-compliant care was not provided.

Objectives

To identify the clinical factors that complicate the diagnosis and management of sepsis and assess their association with SEP-1 compliance and mortality.

Design, Setting, and Participants

This retrospective cohort study was conducted among 590 adults with sepsis in the emergency department of 4 academic hospitals from January 1, 2019, to December 31, 2022. Patients' medical records were reviewed between September 2022 and December 2023.

Main Outcomes and Measures

Study outcomes were (1) characteristics of patients who received SEP-1-compliant care vs characteristics of patients who received noncompliant care and (2) association between SEP-1 compliance and hospital mortality using multivariable models to adjust for successively more potential confounders (first demographics and comorbidities, then infection source, then severity of illness, and then clinical markers of complexity).

Results

Of 590 patients with sepsis (median age, 65 years [IQR, 53-77 years]; 329 men [55.8%]), 335 (56.8%) received SEP-1-compliant care, and 225 (43.2%) received noncompliant care. Compared with patients in the compliant group, patients in the noncompliant group were more likely to be 65 years or older (142 [55.7%] vs 158 [47.2%]; odds ratio [OR], 1.41 [95% CI, 1.01-1.95]), to have multiple comorbidities (Elixhauser score >20: 99 [38.8%] vs 99 [29.6%]; OR, 1.51 [95% CI, 1.07-2.13]), and to have a higher incidence of septic shock (107 [42.0%] vs 107 [31.9%]; OR, 1.54 [95% CI, 1.10-2.16]), kidney dysfunction (87 [34.1%] vs 80 [23.9%]; OR, 1.65 [95% CI, 1.15-2.37]), and thrombocytopenia (43 [16.9%] vs 37 [11.0%]; OR, 1.16 [95% CI, 1.02-2.62]) on presentation. Compared with patients in the compliant group, those in the noncompliant group also had more nonfebrile presentations (136 [53.3%] vs 121 [36.1%]; OR, 2.02 [95% CI, 1.45-2.82]), impaired mental status (92 [36.1%] vs 94 [28.1%]; OR, 1.45 [95% CI, 1.02-2.05]), need for bedside procedures (57 [22.4%] vs 41 [12.2%]; OR, 2.06 [95% CI, 1.33-3.21]), acute concurrent noninfectious illnesses (140 [54.9%] vs 151 [45.1%]; OR, 1.48 [95% CI, 1.07-2.06]), and noninfectious illness as the primary factor associated with their presentation (84 [32.9%] vs 71 [21.2%]; OR, 1.82 [95% CI, 1.08-3.08]). SEP-1 compliance was associated with lower crude mortality rates compared with noncompliance (40 [11.9%] vs 41 [16.1%]; unadjusted OR, 0.60 [95% CI, 0.37-0.98]), but there was no statistically significant difference between groups after successively adjusting for demographics and comorbidities (adjusted OR [AOR], 0.71 [95% CI, 0.42-1.18]), infection source (AOR, 0.71 [95% CI, 0.43-1.20]), severity of illness (AOR, 0.86 [95% CI, 0.50-1.49]), and clinical markers of complexity (AOR, 1.08 [95% CI, 0.61-1.91]).

Conclusions and Relevance

In this cohort study of adults with sepsis, complex clinical presentations were more common among patients whose treatment was noncompliant with SEP-1. These nuances are poorly captured in most observational studies but confound the association between SEP-1 compliance and mortality.

Relevance of anatomical remnants for revision sinus surgery

OBJECTIVES

Review of the scientific literature dedicated to investigating how residual structures impact surgical outcomes in chronic rhinosinusitis (CRS) patients, providing information on the frequency of anatomical remnants after endoscopic sinus surgery (ESS).

MATERIAL AND METHODS

This review has been reported following the recommendations of the SWiM guideline. PubMed, Cochrane Library, Embase, and Web of Science were searched until April 2024. Studies selected for the systematic review were assessed about quality and risk of bias using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and STROBE. The findings were analyzed descriptively and qualitatively, aligning with EPOS and ICAR guidelines.

RESULTS

Fourteen relevant studies met the inclusion criteria for qualitative synthesis. Prospective and retrospective cross-sectional designs, focusing on revision ESS, were included. Four studies examined full-house functional ESS (FESS), three focused on frontal sinus surgery, four on conventional FESS and three did not specify the surgery type. The risk of bias was assessed, revealing significant variability in study quality and a low level of evidence. Wide variability was found in anatomical structures remaining after ESS, most notably in retained uncinate process (29.6-64%), agger nasi cell (4.5-83.33%) and frontoethmoidal cells (40.7-96.8%). Observations on concha bullosa, septal deviation and lateralization of the middle turbinate revealed distinct patterns among the included studies.

CONCLUSION

This systematic review underscores the persistent challenge of incomplete resection of anatomical structures in revision surgeries for CRS. The variability in the retention of key structures highlights the complexity of surgical outcomes and the need for further refinement in surgical techniques.

Cough in pulmonary rehabilitation: a retrospective analysis of responders and nonresponders

Background

Pulmonary rehabilitation (PR) is essential for people with chronic respiratory diseases (CRDs), yet its impact on cough-related quality of life (CR-QoL) remains unexplored. We assessed the effects of PR on CR-QoL, described the characteristics of responders and nonresponders to PR, and explored determinants of responsiveness in this health domain in individuals with CRDs.

Methods

A retrospective study was conducted. We assessed CR-QoL using the Leicester Cough Questionnaire (LCQ) and the impact of the disease with the COPD Assessment Test (CAT), before and after PR. Cut-offs of <17.05 in LCQ total score and ≥10 in CAT were used to detect low CR-QoL and medium impact of the disease. Responders were defined as achieving a minimal clinically important difference (MCID) of ≥1.3 on the LCQ total score. Pre- versus post-PR analysis involved the t-test, Wilcoxon test or McNemar test and comparisons between groups included the independent t-test, Mann-Whitney U-test or Fisher's exact test. Logistic regression was employed to investigate factors influencing MCID achievement.

Results

135 participants with CRDs (39% females; age 68±10 years; 61% COPD; forced expiratory volume in 1 s (FEV1) % pred 62.6±23.0%) were included. After PR, significant improvements were observed in all LCQ domains and CAT. 31% of participants were identified as responders in the LCQ (36% females; age 66±10 years; 62% COPD; FEV1 % pred 60.0±22.3%), showcasing significant differences in the LCQ and CAT compared to nonresponders. People with low CR-QoL and medium/high impact of the disease at baseline were 11 and 4 times more likely to respond to PR in CR-QoL, respectively.

Conclusion

PR enhances CR-QoL. Identification of CR-QoL and disease impact traits at baseline offers insights to optimise this outcome responsiveness to PR.

The Impact of Enhanced Recovery After Surgery Compliance in Colorectal Surgery for Cancer

Background: This study aimed to assess the impact of Enhanced Recovery After Surgery (ERAS) compliance and to identify which components of this protocol are most likely to affect postoperative outcomes in patients undergoing colorectal cancer surgery. Methods: This is a retrospective cohort evaluating patients who underwent elective colon resection. ERAS compliance was assessed based on adherence to the protocol components. The study examined the following outcomes: postoperative complications, readmission rates, mortality, conversion to open surgery, stoma creation, and length of hospital stay. Results: Of the 410 patients studied, 59% achieved ≥75% compliance. Comparison between compliance groups (<75% versus ≥75%) showed significant differences in overall complications (P = .002), severe complications (P = .001), and length of hospital stay (P < .001). The area under the receiver operating characteristic curve for predicting the absence of severe complications based on ERAS compliance was 0.677 (95% confidence interval: 0.602-0.752). Logistic regression analyses demonstrated that ERAS compliance was significantly associated with a reduced risk of severe complications (P < .001), as well as that the following items: avoiding prophylactic drains (P < .001), minimal use of postoperative opioids (P = .045), avoidance of postoperative salt and water overload (P < .001), postoperative nutritional support (P = .048), and early mobilization (P = .025). Conclusion: High ERAS compliance is associated with improved postoperative outcomes in colorectal cancer surgery. Key protocol components for preventing severe complications include avoiding prophylactic drains, minimal postoperative opioid use, avoiding salt and water overload, nutritional support, and early mobilization.

Virtual Car Seat Installation Program Evaluation: Parent Satisfaction and Installation Accuracy

BACKGROUND

Motor vehicle crashes are a leading cause of preventable death in the United States, but properly used child safety seats significantly reduce the risk of injury and mortality. In-person car safety seat installation programs were suspended during the COVID-19 pandemic, prompting the development of virtual alternatives. However, the effectiveness of these virtual installation programs remains unknown.

OBJECTIVE

The study aims to evaluate the effectiveness of a virtual car seat installation and safety check program on parental satisfaction, perceived value, confidence, and correct child safety seat installation.

METHODS

This single-center retrospective cohort study was conducted over 2 years (2020-2022) at a Level I pediatric trauma center in the Northeastern United States for parents participating in child safety seat programs. The pilot study evaluated the effectiveness of virtual car seat installation and safety checks on parental self-reported satisfaction, perceived value, and confidence levels before and after the intervention.

RESULTS

A total of n = 375 study participants received the intervention and follow-up surveys, with n = 129 respondents completing the survey for a 34% response rate. The study included child safety seats from 18 manufacturers and vehicles representing 25 brands. Before the intervention, 57% of parents reported the inability to install their child's safety seat safely. Following intervention, 100% of parents achieved proper car seat installation (p < .0001).

CONCLUSION

We found that offering a virtual car seat installation and verification program is a viable option when in-person options are not feasible.

The role of family caregiving in the management of individuals with mental illnesses and the outcome of family-based interventions for mental illnesses in China: a scoping review

The effects of China's rapid economic development and urbanisation on family caregivers' responsibilities for providing essential practical, social, and psychological support to family members with mental illnesses are unclear. This scoping review identified 176 relevant studies published from 1 January 2000 to 31 December 2023 in six English-language and three Chinese-language databases. Most studies focus on family caregiving for individuals with schizophrenia (63 studies), autism (40 studies), or dementia (39 studies). Family caregiving-subclassified as informational, concrete, or psychological-was beneficial both for patients and their family members, but providing support often necessitated substantial sacrifices by family caregivers, many of whom experience psychological distress and financial difficulties. The type and intensity of the support provided are influenced by the severity of the patient's symptoms, financial and other resources of the patient's family, community members' beliefs about mental illnesses, and the local availability of mental health and social welfare services. Results from intervention studies indicate that different methods of enhancing family caregiving improved outcomes for individuals with mental illnesses. However, the methodological quality of the intervention studies was poor, and most of the studies were conducted in inpatient settings, so the benefits of these family-based strategies remain uncertain. Rapid economic development and urbanisation in China are resulting in fundamental changes in the relative responsibilities of different stakeholders for providing social welfare services-individuals, families, communities, and governmental agencies. Understanding and enhancing the role that families play in the support of community members with mental illnesses will require improving the quality of research about this issue, expanding the range of mental health conditions considered, and, most importantly, developing a dynamic overarching theoretical framework that integrates the many factors influencing ongoing changes in the structure and functioning of Chinese families.

Process and outcome differences in the care of patients undergoing elective and emergency right hemicolectomy

INTRODUCTION

Up to 30% of patients with colorectal cancer present as an emergency and have worse outcomes than elective patients. Compared with left-sided cancers, malignancies arising in the right colon are significantly under-researched. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer (RCC).

METHODS

This multicentre, retrospective study included all patients who underwent operative management for a RCC, from 1 April 2017 to 31 March 2022. Data were collected from electronic patient records, and host and tumour factors as well as outcomes between emergency and elective cohorts were compared.

RESULTS

Overall, 806 patients (median age 72 years) were included. Some 175 patients (22%) presented as an emergency: 140 in obstruction and 35 with tumour perforation, compared with 1 patient with tumour perforation in the elective group (p < 0.001). The emergency group had higher rates of postoperative complications (59.1% vs 20.0%, p < 0.001), increased 90-day mortality (13.7% vs 1.3%, p < 0.001) and a longer hospital stay (5 vs 10 days, p < 0.001). From the emergency cohort only 29.2% of eligible patients received adjuvant chemotherapy and in multivariate regression analysis emergency presentation was associated with a decreased likelihood of receiving adjuvant chemotherapy (odds ratio 0.26 [0.14-0.47], p < 0.001).

CONCLUSIONS

Both short- and long-term outcomes after emergency presentation of RCC are poor, with inadequate access to subsequent chemotherapy. Strategies addressing emergency presentations of left-sided tumours have moved towards temporisation and elective surgery. Delaying major resectional surgery for optimisation may improve outcomes and access to adjuvant therapies for RCC.

The Impact of Cardiac Damage on In-Hospital Outcomes for Patients With Aortic Stenosis in the United States: An Analysis From The National Inpatient Sample

INTRODUCTION

The objective of this study is to determine if cardiac damage based on hospital discharge codes is associated with in-hospital outcomes in patients with aortic stenosis (AS).

METHODS

We conducted a retrospective cohort study of hospital admissions between 2016 and 2021 with a diagnosis of AS in the National Inpatient Sample (NIS). The cardiac damage stages 0-4 were determined based on hospital discharge codes. Logistic and linear regressions were used to determine the association between cardiac stage and in-hospital mortality, length of stay (LoS) and cost.

RESULTS

A total of 2,980,150 hospital admissions were included in the analysis (82.5% conservative management, 11.2% transcatheter aortic valve replacement [TAVR], 6.3% surgical aortic valve replacement [SAVR]). The association between cardiac damage stage and in-hospital outcome was most significant for patients who had SAVR treatment (stage 4 vs. stage 0: mortality OR 27.70 95% CI 17.35-35.17, LoS 7.34 95% CI 6.34-8.35, cost 70,710 95% CI 65,110-76,310) compared to TAVR treatment (stage 4 vs. stage 0: mortality OR 9.15 95% CI 5.52-15.15, LoS 6.27 95% CI 5.63-6.90, cost 28,384 25,084 to 31,684) and conservative treatment (stage 4 vs. stage 0: mortality OR 3.55 95% CI 3.13-4.04, LoS 2.09 95% CI 1.87 to 2.31, cost 6362 95% CI 5642-7083).

CONCLUSIONS

Cardiac damage can be evaluated using diagnostic codes in patients with AS and it is associated with in-hospital mortality, LoS and cost, and has more impact on these outcomes in patients treated with SAVR versus those treated with TAVR.

Long-term outcome for neoadjuvant versus adjuvant chemotherapy in early breast cancer and the prognostic impact of nodal therapy response: A population-based study

INTRODUCTION

Although neoadjuvant systemic treatment for non-metastatic breast cancer has gained ground during the past decade, there is no compelling evidence that it improves overall survival compared to primary tumor resection and adjuvant treatment. At the same time, the approach to responders to neoadjuvant treatment in the axilla is evolving.

MATERIALS AND METHODS

This is a retrospective analysis of a prospectively collected population-based registry. Patients that received neoadjuvant (n = 2126) or adjuvant chemotherapy (n = 4754) for non-metastatic breast cancer during 2007-2020 in the Stockholm-Gotland region, which comprises 25 % of the entire Swedish population, were included. Overall survival of patients treated preoperatively and postoperatively was compared using inverse probability treatment weighting and landmark analysis. The prognostic impact of change between prechemotherapy clinical to postchemotherapy pathologic nodal stage (cN/pN) in women receiving neoadjuvant treatment was investigated.

RESULTS

Median follow-up was 4.93 years. There was no difference in adjusted overall survival between adjuvant (reference) and neoadjuvant treatment in the entire population (HR = 1.38, 95 % CI 0.98-1.93, p = 0.062) or in breast cancer subtypes. Patients converting from positive clinical to negative pathologic nodal stage (cN+/pN0) had improved outcomes compared to cN0/pN0 or patients with pN0 following primary surgery. These patients had a particular disease trajectory, with early peak in risk of death followed by quick and sustained decrease.

CONCLUSION

There was no difference in survival of patients treated with neoadjuvant versus adjuvant systemic therapy for non-metastatic breast cancer. Patients with cN+/pN0 have excellent prognosis and represent potential candidates for de-escalation of local and systemic treatment.

Effect of Cannabis Usage on Thyroid Eye Disease

PURPOSE

The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in patients with autoimmune hyperthyroidism. While the association between cigarette smoking and TED is well established, the effect of cannabis on TED is unclear.

METHODS

This cohort study examined data from TriNetX, an electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003, and December 1, 2023. Primary outcomes were TED presentation (exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuropathy) and treatment (teprotumumab, methylprednisolone, tarsorrhaphy, and orbital decompression) in cannabis users, nicotine users, and control patients. Propensity matching was performed to control for characteristics such as age, sex, race, prior thyroidectomy, and/or radio ablation. Relative risk between cohorts was calculated for each outcome in 6-month, 1-year, and 2-year intervals following diagnosis of autoimmune hyperthyroidism.

RESULTS

Of 36,186 patients with autoimmune hyperthyroidism, 783 were cannabis users, 17,310 were nicotine users, and 18,093 were control patients without cannabis or nicotine usage. Compared with control patients, cannabis users were more likely to be younger, male, and Black/African American and have anxiety or depression. After propensity matching, cannabis users were 1.9 times more likely to develop exophthalmos ( p = 0.03) and 1.6 times more likely to develop any TED presentation ( p = 0.049) in the 1-year interval although these differences did not remain statistically significant in the 2-year interval.

CONCLUSIONS

Cannabis users had a significantly increased risk for TED outcomes in the 1-year interval. Further research is needed to inform TED management.

Racial and Ethnic Disparities in Screening Mammography During COVID-19 in the Upper Midwest

OBJECTIVE

Studies conducted prior to COVID-19 suggested that racial and ethnic disparities in mammographic screening have reduced over time. COVID-19 has had devastating effects on racial and ethnic minority populations, resulting in delays in preventive screening. Our purpose was to determine if racial and ethnic minority groups were less likely to receive mammographic screening during the COVID-19 pandemic.

METHODS

Retrospective cross-sectional study was conducted in a multisite academic medical center in the Upper Midwest to evaluate screening disparities during the COVID-19 pandemic. Participants included 50- to 74-year-old female individuals (June 2021 to May 2022). Additional control group was included for pre-COVID-19 case-control comparison (June 2018 to May 2019). Unadjusted and adjusted logistic regression analyses estimated the association between screening and race and ethnicity including interaction terms to assess temporal interactions associated with COVID-19. Study was deemed exempt from institutional review board review.

RESULTS

In all, 37,509 eligible female patients were included. Of them, 73.8% of eligible patients received a mammogram within the last 2 years (White 74.7%, Black 57.6%, Asian 67.0%, American Indian 60.1%, Hispanic 64.2%). In our adjusted analyses, Black (P < .001), Asian (P = .003), and American Indian patients (P = .001) were less likely to receive screening. Hispanic patients were comparably likely to receive screening (P = .338). Non-English-preferred languages, uninsured or Medicaid, and living in rural areas were associated with decreased screening (P < .001). In all, 36,768 eligible female patients were included for pre-COVID-19 comparison. Compared with the pre-COVID-19 time period, COVID-19 was associated with increased screening disparities (P < .001) for Black and Hispanic women (P < .001).

CONCLUSION

The COVID-19 pandemic was associated with increased racial and ethnic screening disparities. Targeted outreach efforts are required to ensure equitable access to mammographic screening for medically underserved patient populations.

Defining and Predicting Early Recurrence for Optimal Treatment Strategies for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Study

BACKGROUND

Early recurrence in intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) is poorly defined. Predictors are lacking and needed for patient counseling, risk stratification, and postoperative management. This study aimed to define and predict early recurrence for patients in resected IPMN-derived PDAC and guide management.

METHODS

A lowest p value for survival after recurrence (SAR) was used to define early recurrence in resected IPMN-derived PDAC from five international centers. Overall survival (OS) and SAR were compared using log-rank tests. A multivariable logistic regression identified odds ratios (ORs) with 95 % confidence intervals (CIs) for early recurrence. Rounded ORs were used to stratify patients into low-, intermediate-, and high-risk groups using upper and lower quartile score distributions. Adjuvant chemotherapy was assessed by Cox regression and log-rank tests for OS in risk groups.

RESULTS

Recurrence developed in 160 (42 %) of 381 patients. Early recurrence was defined at 10.5 months and observed in 61 patients (38 % of recurrences). The median SAR for the patients with early recurrence was 8.3 months (95 % CI, 3.1-16.1 months) compared with 12.9 months (95 % CI, 5.2-27.5 months) for the patients with late recurrence. The independent predictors of early recurrence were CA19-9 (OR, 3.80; 95 % CI, 1.54-9.41) and N2 disease (OR, 7.29; 95 % CI, 3.22-16.49). The early recurrence rates in the low-, intermediate-, and high-risk groups were respectively 1 %, 14 %, and 32 %. Adjuvant chemotherapy was associated with improved OS only for the high-risk patients (hazard ratio, 0.50; 95 % CI, 0.32-0.79).

CONCLUSION

In IPMN-derived PDAC, the optimal cutoff for early recurrence is 10.5 months. Both CA19-9 and N stage predict early recurrence. Adjuvant chemotherapy is associated with survival benefit only for high-risk patients.

Vertebroplacental ratio for prediction of perinatal outcome and operative delivery for suspected fetal compromise: prospective observational cohort study

OBJECTIVE

To investigate differences in fetal vertebroplacental ratio (VPR) depending on the occurrence of operative delivery for suspected fetal compromise (ODFC) and composite perinatal outcome (CPO) at delivery.

METHODS

This was a prospective observational cohort study conducted in the Department of Obstetrics and Gynecology at the University Hospitals of Leuven, Leuven, Belgium, between December 2022 and April 2024. Women with a term (37-42 gestational weeks) singleton pregnancy with an appropriate-for-gestational-age (AGA) fetus were recruited, before cervical dilatation reached 5 cm, for sonographic fetal weight estimation (EFW) and Doppler sonography of the umbilical artery (UA), umbilical vein (UV), middle cerebral artery (MCA) and vertebral artery (VA). The primary outcomes were differences in VPR multiples of the median (MoM) depending on the occurrence of ODFC and CPO at delivery (based on UA cord blood pH and base excess, 1-min and 5-min Apgar score, and neonatal intensive care unit admission). We explored the technical feasibility of fetal Doppler sonography in this setting and differences in Doppler findings from individual fetal vessels (UA, UV blood flow (UVF), MCA, VA) and related parameters (UVF/EFW and cerebroplacental ratio (CPR)). We also investigated whether adding individual sonographic variables to baseline clinical prediction models could improve discriminatory power (using the area under the receiver-operating-characteristics curve (AUC)) and predictive accuracy (using the Brier score) for both outcomes.

RESULTS

A total of 161 women were recruited. The mean ± SD maternal age was 32.2 ± 3.8 years and approximately half (53.4%) of the women were nulliparous. Most (88.2%) women had labor induced. The mean ± SD gestational age at delivery was 39.3 ± 1.0 weeks and the mean ± SD ultrasound-to-delivery interval was 10.4 ± 2.75 h. An adverse CPO occurred in 13.3% of cases and ODFC occurred in 17.4%. No difference in mean VPR MoM was observed between cases with normal vs adverse CPO (1.04 ± 0.26 vs 1.17 ± 0.25; P = 0.09), or between cases which underwent ODFC vs those which did not (1.06 ± 0.29 vs 1.06 ± 0.26; P = 0.97). Likewise, no differences in other Doppler variables (UA pulsatility index (PI) MoM, MCA-PI MoM, VA-PI MoM, CPR MoM) were observed for both outcomes, except for significantly higher UVF rates in the adverse CPO group (both absolute (P = 0.02) and corrected for EFW (P = 0.048)). For both outcomes, adding VPR MoM or any other sonographic variable to baseline prediction models, which consisted solely of clinical variables, did not improve predictive accuracy or discriminatory power. The baseline model AUC and Brier score values were 0.68 (95% CI, 0.57-0.79) and 0.14 for adverse CPO, and 0.72 (95% CI, 0.61-0.83) and 0.13 for ODFC, respectively.

CONCLUSIONS

Although technically feasible to measure in most women with an AGA fetus admitted for spontaneous or induced labor at term, no difference in VPR MoM was observed depending on the occurrence of ODFC or CPO at delivery. Moreover, adding VPR MoM or any other sonographic variable to a baseline clinical prediction model did not improve predictive accuracy or discriminatory power for either outcome. Hence, peripartum ultrasound for the assessment of fetal weight and placental function has limited added value for predicting adverse labor outcomes in a low-risk obstetric population. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Dose-response relationship between awake prone-positioning duration and PaO2/FiO2 changes and risk of disease aggravation in patients with severe COVID-19: A prospective cohort study

BACKGROUND

Patients not mechanically ventilated often fail to achieve the recommended duration of awake prone positioning due to treatment interruption and discomfort. Few studies have investigated the link between treatment outcome and prone-positioning duration, the inability to accurately guide patients to perform awake prone positioning.

OBJECTIVES

The aim of this study was to characterise and explore the relationship between awake prone-positioning duration with the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2 [P/F]) changes and the risk of disease aggravation.

METHODS

A prospective cohort study; dose-response relationship was used. Awake prone positioning was performed on patients with severe Corona Virus Disease 2019 (COVID-19) for 5 consecutive days from 1 February to 21 March 2023. Linear and logistic regression models were utilised to assess the association between prone-positioning duration with P/F changes and risk of disease aggravation, respectively. Meanwhile, the restricted cubic spline was used to evaluate the dose-response relationships.

RESULTS

A total of 408 patients with severe COVID-19 were analysed. The daily prone positioning duration was 4.57 ± 2.74 h/d, and the changes in P/F were 67.63 ± 69.17 mmHg. On the sixth day of hospitalisation, the condition of 52 (12.8%) patients deteriorated. There was a positive, nonlinear dose-response relationship (Poverall < 0.001, Pnonlinearity = 0.041) and a strong, significant positive correlation (β = 29.286, t = 4.302, P < 0.001) between the prone-positioning duration and P/F changes. The risk of disease aggravation gradually decreases with the increase of prone-positioning duration. Nonetheless, the prone-positioning duration was not statistically associated with disease aggravation (odds ratio = 0.986, 95% confidence interval: 0.514-1.895).

CONCLUSIONS

Awake prone positioning for ≥4 h/d is effective on oxygenation (not mortality/intubation) and is achievable for patients with severe COVID-19. Prolonged prone positioning is promising in improving patients' oxygenation but does not alleviate their risk of disease aggravation.

Comparison of P-wave parameter changes after radiofrequency ablation and cryoballoon ablation for paroxysmal atrial fibrillation: An observational cohort study

BACKGROUND

Pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) can be performed using one-shot cryoballoon ablation (cryo) or point-by-point radiofrequency ablation (RF). This study compares the changes in P-wave parameters between both ablation methods.

METHODS

This single-centre retrospective study included contact force RF and second-generation cryo for PAF between 2018 and 2019. Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12‑leads ECGs with 1-50 hertz bandpass filters were monitored directly during the procedure. Corrected P-wave duration (PWDc), P-wave voltage (PWV), P-wave dispersion (PWDisp), and P-wave terminal force in V1 (PTFV1) were measured and compared between RF and cryo. Additional ablations outside pulmonary veins were excluded.

RESULTS

The final analysis included 226 patients, and the freedom of AF rate was similar at the 12-month follow-up between RF and cryo (76 % vs 74 %, P = 0.12). PWDc and PWV increased and decreased, respectively in both arms. PTFV1 decreased in RF (-3.3 mm.s to -4.6 mm.s, P < 0.001) and cryo (-3.4 mm.s to -5.3 mm.s,P = 0.002). There were similar changes after RF and cryo in PWDc (F11, 1032 = 0.80, P = 0.85), PWV (F11, 1032 = 0.19,P = 0.06), and PWDisp (F11, 1032 = 0.16,P = 0.34) and PTFV1 (P = 0.39). Increased PWDc was correlated with failure of RF (hazard ratio [2.3], 95 % confidence interval [CI]: 1.4-5.9, p = 0.01) and cryo (HR: 2.1, 95 % CI (1.3-4.6), p = 0.02). Results were similar when patients on antiarrhythmic drugs were excluded.

CONCLUSION

RF and cryo caused similar freedom of AF rate at 12 months in PAF and similar P-wave parameter changes.

Optimizing length of hospital stay among inpatients with spinal cord injury: An observational study

INTRODUCTION AND OBJECTIVES

Despite the importance of length of stay (LOS) following spinal cord injury, it remains underexplored in the literature. This study aims to bridge this gap by investigating the association between rehabilitation LOS and functional gains among patients with traumatic (TSCI) or non-traumatic (NTSCI) spinal cord injuries.

METHODS

We conducted a retrospective observational cohort study assessing functional gains using the motor Functional Independence Measure (mFIM) and the Spinal Cord Independence Measure (SCIM III) from rehabilitation admission to discharge. Outcomes were analyzed across four neurological categories based on the American Spinal Injury Association Impairment Scale (AIS): C1-C4 AIS A-C; C5-8 AIS A-C; T1-S5 AIS A-C; and AIS D. Linear regression models estimated changes across rehabilitation LOS quarters (Q1-Q4), adjusting for covariates.

RESULTS

We included 1036 patients admitted for rehabilitation between 2007 and 2023 (46.3% TSCI, 53.7% NTSCI). TSCI: age 42.7, 80.2% male, 41.8% AIS A, LOS 90.5. NTSCI: age 55.7, 54.2% male, 14.2% AIS A, LOS 69.6. For TSCI, mFIM and SCIM III gains increased significantly from Q1 to Q2 (T1-S5-ABC, n=214) and Q2 to Q3 (AIS D, n=129). For NTSCI, gains increased from Q2 to Q3 (T1-S5-ABC, n=195) and from Q1 to Q2 as well as from Q2 to Q3 (AIS D, n=304). Adjusted models showed decreasing gains for Q2 and Q3 vs. Q1 (TSCI) but increasing gains for Q2-Q4 vs. Q1 (NTSCI) for both measures. No significant gains were observed from Q3 to Q4.

CONCLUSIONS

We identified specific neurological categories and LOS quarters yielding to significant functional gains.

Domestic and family violence and associated maternal and perinatal outcomes: A population-based retrospective cohort study

BACKGROUND

Domestic family violence (DFV) is a global health concern affecting one in three women worldwide. Women are vulnerable to DFV throughout their life; however, pregnancy introduces an increased risk of experiencing DFV for millions of women and birthing people.

METHODS

Routinely collected data from two hospitals in one local health district in New South Wales, Australia, were examined to determine the prevalence of DFV from 2010 to 2019. Demographics and outcome factors were compared by a reported history of DFV. Multivariable logistic regression was used to assess for predictors of DFV and to assess DFV as a predictor of adverse maternal and perinatal outcomes.

RESULTS

One percent of women (538/52,469) experienced DFV in the past year. Women experiencing domestic violence were more likely to be younger and have previous children, and had higher Edinburgh Depression Scores. These women were more likely to experience stillbirth (1.5% vs. 0.6%, p = 0.005). Maternal age < 25 years, cigarette smoking, alcohol use in pregnancy, mental health issues, and place of birth were associated with a recent history of DFV after adjusting for confounders. Recent DFV was associated with preterm birth and mental health issues but was not associated with admission to the neonatal nursery, small-for-gestational-age birthweight, or caesarean section after adjusting for confounders.

CONCLUSION

There was a relationship between DFV and poorer health outcomes for both women and their babies. This study highlighted that stillbirth is high among the population of women who experience DFV when compared to women who do not experience DFV.

Prevalence of the use of oral nutritional supplements among acute inpatients at risk of malnutrition and associated patient characteristics

AIM

To provide a snapshot of the current use of oral nutritional supplements, its association with inpatient characteristics, and with a focus on the role of nursing monitoring of food intake and implementing nutritional interventions for patients with low intake.

DESIGN

Retrospective cohort study.

METHODS

The study collected data from a hospital database regarding oral nutritional supplement initiation and variables of patients hospitalised in internal medicine departments, who did not receive enteral or parenteral nutrition.

RESULTS

Of the 5155 admissions, 1087 fulfilled the inclusion criteria (47% female; mean age, 72.4 ± 14.6 years; mean length of stay, 14.6 ± 11.4 days). Sufficient food intake reporting was noted in 74.6% of the patients; of these 17% had decreased intake. Oral nutritional supplements and non-oral nutritional supplements groups did not differ in terms of sex, age, length of stay, Charlson Comorbidity Index, proportion of nursing reports, and absence of intake monitoring. Oral nutritional supplements were initiated in 31.9% of patients with a Malnutrition Universal Screening Tool score ≥2 and in 34.6% with decreased food intake. On multivariable analysis, hypoalbuminemia (adjusted odds ratio, 3.70), decreased food intake (adjusted odds ratio, 3.38), Malnutrition Universal Screening Tool score ≥2 (adjusted odds ratio, 2.10), and age <70 years (adjusted odds ratio, 1.56) were significantly associated with oral nutritional supplements use.

CONCLUSION

The prevalence of oral nutritional intervention was suboptimal in patients at risk of malnutrition during acute hospitalisation, although decreased food intake and Malnutrition Universal Screening Tool score ≥2 independently increased the probability of oral nutritional supplements initiation.

RELEVANCE IN CLINICAL PRACTICE

Understanding the clinical practice and nursing impact of care management in relation to nutritional intervention can assist in reviewing and improving patient care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE IMPACT (ADDRESSING): This study informs clinical management and influences nursing practice standards related to assessing, monitoring, and managing malnutrition risk.

IMPACT

The study impacts the quality of care for patients at risk of malnutrition.

REPORTING METHOD

We adhered to the STROBE Checklist for cohort studies.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Treatment Utilisation and Satisfaction With Management in Individuals With Osteoarthritis and Metabolic Multimorbidity: A Cross-Sectional Multi-Country Study

PURPOSE

To compare treatment utilisation for osteoarthritis (OA) and satisfaction with OA management between individuals with and without comorbid metabolic conditions (e.g., diabetes, obesity, dyslipidaemia, hypertension).

METHODS

Secondary analysis of a cross-sectional international survey study (Italy, Russia, Sweden) on people ≥ 40 years old with knee/hip OA. Metabolic comorbidity was self-reported. We used direct standardisation with prevalence ratios and mixed-effect models to estimate the associations between comorbidity with treatment utilisation and satisfaction (score 0-100).

RESULTS

We analysed 401 individuals (48% Sweden, 28% Italy, 24% Russia; 53% with ≥ 1 metabolic condition). Those with and without comorbid metabolic conditions showed similar prevalence for first-line interventions (exercise, education, and weight management). Metabolically unhealthy individuals showed higher use of opioids (prevalence ratio [95% CI] 1.9 [1.3-2.4]), antidepressants (1.8 [1.1-2.5]), corticosteroid injections (1.4 [1.0-1.8]), and homoeopathic products (2.1 [1.2-3.0]). Satisfaction with care (adjusted difference: -3.9 [95% CI: -8.5 to 2.4]) and information received about treatments (-4.0 [-9.7 to 1.7]) were similar.

CONCLUSIONS

While first-line OA interventions were similarly used, those with metabolic conditions relied more on second-line and non-recommended treatments, showing comparable satisfaction. More effort is needed to increase the adoption of lifestyle-focused treatments in OA and to minimise the use of less recommended options among individuals with metabolic comorbidities.

The Prevalence and Predictors of Atrioventricular Blocks in Syrian Patients Reporting to the Emergency Department During the Ongoing Conflict: A Cross-Sectional Study

BACKGROUND

Atrioventricular block (AVB) is a cardiac conduction disorder that can lead to significant clinical outcomes, particularly in resource-limited and conflict-affected regions. In Syria, healthcare infrastructure has been severely impacted by ongoing conflict, potentially affecting the prevalence and management of AVB.

METHODS

We conducted a cross-sectional study at Tishreen University Hospital in Latakia, Syria, with patients > 40 who presented to the emergency department (ED) from June 1 to August 1, 2024. Routine 12-lead ECGs were performed, with AVB diagnoses confirmed by two independent cardiology consultants. Exclusion criteria included pre-existing AVB, pacemaker presence, hemodynamic instability, and ECG diagnostic discrepancies. Patient demographics and comorbidities were assessed, and logistic regression analyses identified predictors of AVB.

RESULTS

The final analysis included 692 patients, of which AVB was detected in 7% of the cohort. Patients with AVB were significantly older (median age 76 vs. 54 years, p < 0.001) and had higher rates of ischemic heart disease (IHD) (62% vs. 14%, p < 0.001) and diabetes (56% vs. 21%, p = 0.01). Logistic regression showed older age (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.6-5.6, p < 0.001), IHD (OR: 1.9, 95% CI: 1.4-4.5, p < 0.001), and DM (OR: 3.9, 95% CI: 2.9-8.3, p < 0.001) were independently associated with AVB.

CONCLUSION

AVB prevalence in the Syrian ED setting is high, with age, IHD, and diabetes as significant predictors. Routine ECG screening in EDs may facilitate early AVB detection in at-risk populations, especially in conflict-affected regions with limited healthcare resources. This approach could improve outcomes by enabling timely intervention in high-risk patients.

Exploring the Italian Population's attitudes toward health data sharing for healthcare purpose and scientific research: a cross-sectional study

BACKGROUND

This study aimed to explore the Italian population's knowledge and perceptions regarding health data storage and sharing for treatment and research and to identify factors associated with citizens' attitudes toward data storage and sharing.

METHODS

A cross-sectional questionnaire, distributed to 1389 participants, collected sociodemographic information, assessed knowledge and gauged attitudes toward sharing data for treatment and research. Descriptive analyses and logistic regressions were performed to examine the associations between sociodemographic factors and knowledge/attitudes about data storage and sharing.

RESULTS

Most respondents wrongly believed that healthcare providers could access personal health-related data across the entire national territory, while 94% expressed willingness to share personal health data nationwide. A substantial percentage of respondents (73%) fully agreed that storing and sharing personal health-related data could improve research and quality of care.Males and younger individuals (<41 years) were likelier to have higher data-sharing knowledge. Lower educational-level respondents exhibited lower positive attitudes towards sharing health data for treatment and research purposes.

CONCLUSIONS

The results provide valuable insights for policymakers, healthcare professionals and researchers seeking to improve data management, promote collaboration and leverage the full potential of health data for personalized care and scientific advancements.

School performance in offspring born to mothers with hyperemesis gravidarum

BACKGROUND

Hyperemesis gravidarum is characterized by severe nausea, vomiting, and potentially undernutrition during pregnancy. Despite affecting up to 3% of all pregnancies, little is known about the impact of hyperemesis gravidarum on the cognitive development of the child.

OBJECTIVE

We aimed to compare the school performance of offspring exposed to hyperemesis gravidarum during pregnancy with their nonexposed counterparts and siblings.

STUDY DESIGN

We conducted a population-based cohort study including all liveborn children, born in Denmark between January 1, 1986, and December 31, 2005. We included 1,162,249 offspring, of which 12,720 (1.1%) had been exposed in utero to a maternal diagnosis of hyperemesis gravidarum. The 2 coprimary outcomes were mean grade point average in the final year of elementary school (ninth grade, 15-16 years) and a composite outcome of low school performance, defined as a mean grade point average below 4 or no registered mean grade point average. The difference in mean grade point average was evaluated using uni- and multivariable linear mixed models and differences in proportions of the binary outcomes were compared using uni- and multivariable logistic regression models.

RESULTS

Of the exposed offspring, 29.3% had low school performance compared to 25.7% of the nonexposed group. After adjustment for confounders (birth year, maternal age, multiple pregnancies, parity, maternal education, maternal smoking, and sex), we found that exposed offspring had increased odds of low school performance (odds ratio 1.19, 95% confidence interval 1.14-1.24). Furthermore, the exposed group had a lower mean grade point average of 6.55 compared with 6.78 in the nonexposed group, yielding an adjusted mean difference of -0.18 (-0.22 to -0.14). However, within-sibling analyses, comparing exposed offspring with their unexposed siblings (same mother), revealed no increased odds of low school performance (adjusted odds ratio 0.98 [0.92-1.04]) or difference in mean grade point average (-0.02 [-0.08 to 0.05]).

CONCLUSION

We found a small association between in utero exposure to hyperemesis gravidarum and low school performance. However, no difference in school performance was observed between exposed and unexposed siblings, indicating that the association could be attributed to genetics or other familial factors rather than hyperemesis gravidarum.

Dual antiplatelets therapy prescription trends and mortality outcomes among senior citizens with acute coronary syndrome: insights from the Malaysian National Cardiovascular Disease Database

OBJECTIVES

To examine 5-year trends and variations in dual antiplatelet therapy (DAPT) prescription among multiethnic Malaysian patients aged 60 years and older.

METHODS

Using the Malaysian National Cardiovascular Disease-Acute Coronary Syndrome (NCVD-ACS) registry, DAPT 5-year temporal trends prescribing patterns at discharge were examined. Multivariate logistic regression was used to calculate the adjusted odds ratio (aOR) of DAPT prescription. The 1-year all-cause mortality by Cox proportional hazard regression model (adjusted hazard ratio, aHR) using inverse proportional weighting covariates adjustment was performed to assess DAPT prognostic impacts.

RESULTS

Data of patients aged 60 years and older were extracted from 2013 to 2017 (n = 3718, mean age: 68 ± 6.74 years, men: 72%, and Malay ethnicity: 43%). The majority of patients were diagnosed with non-ST-segment elevation acute coronary syndrome (63%), predisposed hypertension (76%) and were overweight (74%), while only 35% of patients underwent percutaneous coronary intervention. Over the five years, there was a significant increasing trend in DAPT prescriptions (P < 0.001), with the aspirin-clopidogrel combination being the most common. Aspirin-ticagrelor prescriptions have also increased over the years. Variations in DAPT prescriptions were observed based on patient characteristics. Patients who underwent percutaneous coronary intervention were more likely to be prescribed DAPT in general (aOR = 2.53, 95% CI: 1.95-3.28, P < 0.001) and aspirin-ticagrelor specifically (aOR = 7.76, 95% CI: 5.65-10.68, P < 0.001). Patients with chronic lung disease (aOR = 0.62, 95% CI: 0.42-0.92, P = 0.02) and a history of angina within two weeks (aOR = 0.69, 95% CI: 0.56-0.85, P < 0.001) were approximately 30% less likely to be prescribed DAPT. Approximately 15% of 1-year all-cause mortality were reported. Older patients prescribed DAPT showed significantly higher survival rates than those who were not (aHR < 1.0, P < 0.001). Aspirin-ticagrelor was associated with higher survival rates than aspirin-clopidogrel (aHR = 0.21, 95% CI: 0.11-0.40, P < 0.001).

CONCLUSIONS

Despite the optimal prescription rate and variation of DAPT in the older Malaysian population, there is room for investigation and improvement in the prescription of newer DAPT combinations that have been suggested to improve patient survival.

Impact of Baseline Kidney Function on the Rate of Progressive Kidney Disease After Pregnancy: A Population-Based Cohort Study Research Protocol

Background

Better data are necessary to determine whether baseline level of kidney function affects the rate of progressive kidney disease following pregnancy.

Objective

The objective was to determine whether the baseline (pre-pregnancy) estimated glomerular filtration rate (eGFR) modifies the association between becoming pregnant and the subsequent rate of progressive kidney disease.

Design

Population-based cohort study using provincial administrative health care databases in Ontario and Alberta, Canada.

Setting

The sample will be accrued from April 1, 2007, to March 31, 2023, in Ontario and from April 1, 2012, to March 31, 2023, in Alberta. Follow-up for study outcomes will occur until March 31, 2024.

Participants

The pregnant group will include adult female residents of Ontario or Alberta with a record of a pregnancy of 20 to 46 weeks' gestation during the accrual period, and the non-pregnant group will include adult female residents with no prior record of pregnancy. The cohort entry dates in those in the pregnant group will be the estimated date of conception; the entry dates for those in the non-pregnant group will be randomly assigned following the distribution of dates in the pregnant group. To be eligible, individuals must be between 18 and 45 years old at cohort entry. They require at least 1 serum creatinine measurement within 2 years before entry and should not have received maintenance dialysis or a prior kidney transplant. Both groups will be categorized into one of 3 levels of baseline eGFR (≥60, 45-59, and <45 mL/min per 1.73 m2). Inverse probability of treatment weighting on a propensity score will be used to balance the pregnant and non-pregnant groups on baseline characteristics (including age, proteinuria, hypertension, and diabetes) within the 3 categories of baseline eGFR.

Measurements

The primary outcome, progressive kidney disease, will be defined as a composite of a persistent ≥40% drop in eGFR from the baseline value, a new persistent eGFR <15 mL/min per 1.73 m2, receipt of maintenance dialysis, or receipt of a kidney transplant. The secondary outcomes will be the components of the primary composite outcome examined separately and the annualized change in eGFR in mL/min per 1.73 m2 from baseline.

Methods

We will test for statistical interaction to determine whether the baseline category of eGFR modifies the rate of long-term progressive kidney disease after pregnancy. We hypothesize that a statistical interaction will be present. We will present weighted cause-specific hazard ratios (HRs) and cumulative incidence function (CIF) curves for up to 10 years of follow-up for the pregnant and non-pregnant groups stratified by each eGFR category. We will perform additional pre-specified analyses to confirm whether the findings are robust and examine associations that account for baseline proteinuria.

Results

Based on a feasibility analysis using ICES data in Ontario, we expect the cohort to include over 400 000 pregnant females and 1.2 million non-pregnant females. This includes at least 395 000 pregnant females with baseline eGFR ≥60 mL/min/1.73 m2, 300 with eGFR 45 to 59 mL/min/1.73 m2, and 110 with eGFR <45 mL/min/1.73 m2. The median follow-up is anticipated to be 5 years (range = 1-17 years) with minimal loss to follow-up.

Limitations

Measures of kidney function will be obtained as part of routine care (not according to a research schedule). Measures of baseline proteinuria are frequently missing from routine care data, even in up to 15% of those with an eGFR <45 mL/min per 1.73 m2.

Conclusion

This study will investigate whether the level of baseline eGFR modifies the rate of progressive kidney disease after pregnancy and will estimate the cumulative incidence of progressive kidney disease in pregnant and non-pregnant females across 3 categories of baseline eGFR.

The impact of nurses' adversity quotient on their work stress: the mediating role of professional identity

PURPOSE

To explore the influence of nurses' adversity quotient on their work stress and to further explore whether professional identity can mediate in this process.

METHODS

From July to September 2023, an online questionnaire survey was conducted among nurses in six public tertiary hospitals in Suzhou and Wuxi, China, including demographic information, Adversity Response Profile (ARP), The Professional Identity Scale for Nurses (PIS) and Stress Overload Scale (SOS). Analyzed the collected data using correlation, multiple linear regression, and structural equation modeling.

RESULTS

1,578 nurses completed the questionnaires, resulting in 1,468 valid questionnaires. The average score of Stress Overload Scale of the surveyed nurses was 65.26 ± 17.93 points (Total score of Stress Overload Scale: 110). The correlation analysis showed a significant positive relationship between nurses' adversity quotient and their professional identity (r = 0.59, P < 0.01); professional identity and work stress were negatively correlated (r=-0.44, P < 0.01); and adversity quotient was also negatively correlated with work stress (r=-0.31, P < 0.01). The structural equation model indicated that professional identity might mediate between stress and adversity quotient.

CONCLUSION

Clinical nurses suffer from heavy work stress, and nurses' adversity quotient could change their work stress level by affecting their professional identity. Strategies and measures to improve professional identity is expected to buffer the impact of adversity quotient on nurses' work stress.

Most major bleeds in preterm infants occur in the absence of severe thrombocytopenia: an observational cohort study

OBJECTIVE

To describe the incidence of major bleeds according to different platelet counts in very preterm infants, and to explore whether this association is influenced by other risk factors for bleeding.

DESIGN

Observational cohort study.

SETTING

A Dutch tertiary care neonatal intensive care unit.

PATIENTS

All consecutive infants with a gestational age at birth <32 weeks admitted between January 2004 and July 2022.

EXPOSURE

Infants were stratified into nine groups based on their nadir platelet count (×109/L) during admission (<10, 10-24, 25-49, 50-99, 100-149, 150-199, 200-249, 250-299 and ≥300), measured before the diagnosis of a major bleed and before any platelet transfusion was administered.

MAIN OUTCOME MEASURE

Incidence of major bleeds during admission. Logistic regression analysis was used to quantify the relationship between nadir platelet count and incidence of major bleeds.

RESULTS

Among 2772 included infants, 224 (8%) developed a major bleed. Of the infants with a major bleed, 92% (206/224) had a nadir platelet count ≥50×109/L. The incidence of major bleeds was 8% among infants with and without severe thrombocytopenia (platelet count <50×109/L), 18/231 (95% CI 5 to 12) and 206/2541 (95% CI 7 to 9), respectively. Similarly, after adjustment for measured confounders, there was no notable association between nadir platelet counts below versus above 50×109/L and the occurrence of major bleeds (OR 1.09, 95% CI 0.61 to 1.94).

CONCLUSION

In very preterm infants, the vast majority of major bleeds occur in infants without severe thrombocytopenia.

Manifestations of psychological distress in students from different social groups at the University of São Paulo

OBJECTIVE

To analyze the distribution of manifestations of psychological distress in different social groups of undergraduates from health courses at the University of São Paulo.

METHOD

A cross-sectional study was carried out with undergraduates from 11 health courses at the University of São Paulo. The non-probabilistic sample consisted of 108 students. Data was collected using an online form and analyzed using the SPSS 20.04 and STATA 17 statistical packages. The students were classified into three social groups using the Social Reproduction Index.

RESULTS

188 students took part in the study, 77.4% female; 64.7% white; 69.7% lived in the city of São Paulo and only 4.8% of these lived in student housing. As for the Social Group (SG), 50.5% were classified as SGI, 26.1% as SGII and 23.4% as SGIII/GSIV. Most of the university respondents (77.7%) reported manifestations of psychological distress. The GSI students expressed a lower percentage of manifestations of psychological distress (62.1%) when compared to the other groups.

CONCLUSION

there was a higher prevalence of psychological distress among undergraduates in the GSIII/GSIV groups. The study highlights the importance of implementing policies to deal with psychological distress among university students.

Is Frailty Associated with Worse Outcomes After Major Liver Surgery? An Observational Case-Control Study

Background: The rate of morbidity after liver surgery is estimated at 30% and can be even higher when considering higher-risk subgroups of patients. Frailty is believed to better predict surgical outcomes by showcasing the patient's ability to withstand major surgical stress and selecting frail ones. Methods: This is a single-centre, observational case-control study on patients diagnosed with liver malignancies who underwent liver resections between 2013 and 2024. The five-item modified Frailty Index (mFI-5) was used to split patients into frail and non-frail. The two groups were compared in terms of preoperative, operative and postoperative outcomes using a chi-squared and logistic regression model. Results: A total of 230 patients were included and split into two groups: non-frail, NF, n = 90, and frail patients, F, n = 140. Overall, F patients had a higher rate of morbidity (p = 0.04) but with similar mortality and length of stay. When considering only major liver resections, F patients had a higher probability of posthepatectomy liver failure (LR 6.793, p = 0.009), postoperative bleeding (LR 9.541, p = 0.002) and longer ICU stay (LR 8.666, p = 0.003), with similar rates of bile leak, surgical site infections, length of stay and mortality. Conclusions: Frailty seems to be a solid predictor of posthepatectomy liver failure in patients undergoing major liver resections and is associated with a longer ICU stay. However, mortality and surgical morbidity seem to be comparable between frail and non-frail patients.

Atrial fibrillation screening in Syrian patients reporting to the emergency department during the ongoing conflict: a cross-sectional study

Background

Atrial fibrillation (AF) is the most common arrhythmia worldwide. Data regarding AF screening in conflict countries' emergency departments (ED) is lacking.

Methods

We included consecutive patients >40 years old who reported to the ED of a Syrian tertiary centre between July 2024 and September 2024. Patients had routine 12-lead electrocardiograms (ECGs) regardless of presenting complaints. Two cardiology consultants blindly verified ECG findings. We excluded critically unwell patients and ECG discrepancies between the two consultants. Data were taken from patients' medical notes.

Results

The final analysis included 694 patients, 101 (15%) had AF on the ECG. The most common presenting complaints and ECG abnormality were trauma (44%) and sinus tachycardia (15%), respectively. Compared to the rest of the patients, AF patients were older (66 vs. 59 years; p < 0.001), had a lower proportion of males (39% vs. 54%; p = 0.01), a higher prevalence of diabetes mellitus (49% vs. 21%; p = 0.01), and more cases of congestive cardiac failure (CCF) (38% vs. 17%; p < 0.001). AF patients also had a higher CHA₂DS₂-VASc score (3 vs. 2; p < 0.001). CCF [odds ratio [OR]: 3.3, 95% confidence interval [CI]: 1.5-6.4, p < 0.001] and a higher CHA₂DS₂-VASc score(OR: 4, 95% CI: 1.6-7.7, p < 0.001) were independently associated with positive AF screening.

Conclusion

15% of patients reporting to this Syrian ED had positive AF screening. CCF and CHA₂DS₂-VASc scores are predictive of AF.

The association between age and acute pain sensitivity in patients with Herpes Zoster

Herpes zoster has a well-established increased incidence in older adults, but the relationship between age and acute pain severity remains less clear. This retrospective study aimed to explore the association between age and pain intensity in Herpes zoster patients. A total of 613 patients treated at the Second Affiliated Hospital of Guangxi Medical University were included. Pain intensity was measured using the Numerical Rating Scale-11, and statistical models were applied to evaluate age-related pain differences while controlling for confounders. While older age was associated with higher pain scores (β = 0.02, p < 0.001), the effect size was small. Other factors, such as pain duration and inflammatory markers (e.g., CRP levels), showed stronger associations with pain severity. These findings suggest that age may not be the dominant factor in Herpes zoster pain severity, and a more comprehensive approach is required for risk assessment and pain management in clinical practice.

The relationship between lateral cervical lymph node positivity rate and recurrence after comprehensive treatment in differentiated thyroid carcinoma: a single-center retrospective cohort study from China

Introduction

The lateral cervical lymph node positivity rate has been hypothesized to correlate with the recurrence risk in differentiated thyroid carcinoma (DTC) patients. However, the extent of this association within the Chinese population remains understudied. This study seeks to elucidate the potential causal link between the lymph node positivity rate and DTC recurrence.

Methods

We conducted a retrospective cohort study, examining clinical records of 4,731 DTC patients who received surgical treatment at the First Medical Center of the General Hospital of the Chinese People's Liberation Army from January 2015 to May 2020. The study variables encompassed demographic and clinical characteristics, including sex, age, tumor size, location, laterality, capsular invasion, lymph node metastasis counts, lymph node positivity rates, histological subtypes, Hashimoto's thyroiditis co-occurrence, and the timing of iodine-131 therapy post-surgery. After applying strict inclusion criteria, 1,074 patients were selected for analysis. Recurrence was defined as structural incomplete response (SIR), confirmed by imaging or histological means. The lymph node positivity rate was calculated as the proportion of positive lymph nodes to the total lymph node count.

Results

Multivariate analysis revealed a nonlinear association between the lateral cervical lymph node positivity rate and post-treatment recurrence, with a significant threshold at 0.5. The recurrence risk was substantially elevated with a positivity rate below this threshold (HR: 27.48, 95% CI: 7.21-104.70, P<0.0001), while no significant association was observed above it (HR: 0.17, 95% CI: 0.02-1.57, P=0.119). Subgroup analysis within the high-risk cohort did not yield a significant association between the positivity rate and recurrence risk (HR=0.43, 95% CI: 0.10-1.79, P=0.246).

Discussion

In conclusion, this study identifies a nonlinear relationship between the lateral cervical lymph node positivity rate and the risk of DTC recurrence post-treatment. A positivity rate of less than 0.5 is positively associated with recurrence, while this association diminishes in significance among high-risk patients. This differs from the results previously reported. Further studies are needed to determine the potential mechanisms of the associations observed in observational studies.

Barriers to effective communication in UAE community pharmacies: general public perspectives on enhancing patient-pharmacist interaction and policy development

Background

Community pharmacies serve as accessible points of care, offering essential services such as medication dispensing, health consultations, vaccinations, and chronic disease management, thereby playing a critical role in the healthcare system. This study aims to identify and evaluate the factors that obstruct general public-pharmacist interactions, providing insights to enhance pharmacy environments.

Methods

A total of 406 general publics were surveyed using a validated questionnaire. Statistical analysis was performed with categorical variables presented as frequencies and percentages, and continuous variables as medians with 95% confidence intervals. Binary regression models were used to explore the relationships between sociodemographic characteristics and communication barriers, with a significance level set at p < 0.05 for all analyses.

Results

The primary reasons for pharmacy visits were collecting prescription medications (61.58%) and purchasing OTC products (55.17%), while health screenings were less common (9.11%). Barriers to effective communication included crowded environments (61.58%), limited counseling time (45.81%), and lack of privacy (45.07%). Binary logistic regression revealed that participants who visited the pharmacy weekly were 5.5 times more likely to experience high environmental barriers (OR: 5.502, p = 0.002), while interacting with younger pharmacists increased the likelihood of personal barriers (OR: 12.357, p = 0.025). Pharmacy proximity (75.12%) and shorter waiting times (47.29%) were the most influential factors in pharmacy preference, while additional services had minimal impact (20.2%).

Conclusion

Effective communication is crucial in community pharmacies for high-quality healthcare. This study identifies key barriers in the UAE and offers insights into targeted interventions to improve communication and public satisfaction.

Shared Decision-Making in Severe Aortic Stenosis: Experiences and Needs of Older Patients

BACKGROUND

The experiences and preferences of older patients regarding shared decision-making (SDM) for managing severe aortic stenosis (AS) and its impact on health outcomes are not well known.

OBJECTIVE

The purpose of this study was to provide insight into the experiences, preferences, and needs for SDM of older patients with severe AS and the associations between perceived SDM levels and patients' quality of life, depression, and anxiety.

METHODS

A descriptive, exploratory multiple-methods study was conducted using a survey, focus groups, and individual interviews with patients 70 years and older with severe AS. Data were collected at baseline and at 3-month follow-up. Quantitative data were analyzed using multivariate linear regression and quantitative data using qualitative thematic analysis.

RESULTS

Quantitative analysis (n = 120) showed that 29.6% of patients reported maximum scores for the perceived SDM level. In addition, the perceived SDM level was significantly associated with the quality of life category environment (B = 2.75; 95% confidence interval, 0.90-4.61; P = .004). Professionals' identification of discussion partners was reported by 41.3% of patients, and 52% of patients reported professionals' exploration of patients' daily lives. For future decision-making, 55.6% of patients preferred a collaborative role. Qualitative analysis of 2 focus groups (n = 10) and interviews (n = 7) revealed patients' preference for informal caregivers' support for decision-making. Patients expressed caution in sharing views on their daily lives and expectations and suggested better preparation and goal exploration for decision-making.

CONCLUSIONS

To align with SDM and personalize the decision-making process, healthcare professionals must foster patient input and engage informal caregivers. Patients must reflect on their daily activities to define their treatment goals.

Racial and ethnic disparities in longitudinal trajectories of cardiovascular risk factors in U.S. middle-aged and older adults

BACKGROUND

Racial and ethnic disparities in cardiovascular disease (CVD) risk factors are well-documented. However, racial and ethnic differences in the longitudinal changes among multiple CVD risk factors are unknown.

METHODS

We used prospective cohort data of U.S. adults aged ≥50 in the 2006-2016 Health and Retirement Study. Group-based multi-trajectory models characterized age-related trajectories of systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dL), diabetes mellitus (DM), and smoking. Racial and ethnic differences in the multi-trajectory profiles were examined using multinomial logistic regression. Karlson-Holm-Breen methods were used to assess factors contributing to these associations.

RESULTS

Among 10,292 participants (median age: 61), approximately 32% had an overall favorable profile of CVD risk factors. Compared with non-Hispanic White adults, non-Hispanic Black adults were more likely to exhibit elevated systolic BP with high risks of DM (relative risk ratio [RRR] = 3.36; 95% CI, 2.69-4.21; P < .001) and with low risks of DM (RRR = 3.23; 95% CI, 2.38-4.38; P < .001). Non-Hispanic Black adults were also more likely to exhibit high rates of smoking with and without other co-occurring risk factors. Hispanic adults were most likely to exhibit high risks of DM with elevated systolic BP (RRR = 1.74; 95% CI, 1.28-2.38; P < .001) and without elevated systolic BP (RRR = 1.90; 95% CI, 1.50-2.40; P < .001). Education, income, and country-of-origin were significantly associated with the excess CVD risks observed among racial and ethnic minority groups.

CONCLUSIONS

Significant racial and ethnic disparities were observed in trajectories of CVD risk factors in U.S. adults. Social determinants largely contributed to these associations in non-Hispanic Black adults and Hispanic adults.

Endoscopic papillectomy versus surgical ampullectomy for adenomas and early cancers of the papilla: a retrospective Pancreas2000/European Pancreatic Club analysis

OBJECTIVE

Ampullary neoplastic lesions can be resected by endoscopic papillectomy (EP) or transduodenal surgical ampullectomy (TSA) while pancreaticoduodenectomy is reserved for more advanced lesions. We present the largest retrospective comparative study analysing EP and TSA.

DESIGN

Of all patients in the database, lesions with prior interventions, benign histology advanced malignancy (T2 and more), patients with hereditary syndromes and those undergoing pancreatoduodenectomy were excluded. All remaining cases as well as a subgroup of them, after propensity-score matching (nearest-neighbour-method) based on age, gender, anthropometrics, comorbidities, size and histological subtype, were analysed. The median follow-up was 21 months (IQR 10-47) after the primary intervention. Primary outcomes were rates of complete resection (R0) and complications. Groups were compared by Fisher's exact or χ2 test, Mann-Whitney-U-test and log-rank test for survival.

RESULTS

Of 1673 patients in the database, 1422 underwent EP and 251 TSA. Of them, 23.2% were excluded for missing or inconclusive data and 19.8% of patients for prior interventions or hereditary syndromes. Final histology showed in 24.2% of EP and 14.8% of TSA patients a histology other than adenoma or adenocarcinoma while advanced cancers were recorded in 10.9% of EP and 36.6% of TSA patients. Finally, 569 EP and 63 TSA were included in the overall analysis, with a higher rate of more advanced cases and higher R0 resection rates in the TSA groups (90.5% vs 73.1%; p<0.01), with additional ablation in the EP group in 14.4%. Severe adverse event rates were 3.2% (TSA) vs 1.9% (EP). Recurrence after histological R0 resection was 16% (EP) vs 3.2% (TSA; p=0.01), and additional therapy for R1 resection was applied in 67% of the 159 cases. Propensity-score-based matching identified 62 pairs of EP/TSA patients with comparable baseline patient and lesion characteristics. The initial R0-rate was 72.6% (EP) compared with 90.3% (TSA, p=0.02) with recurrences found in 8% (EP) vs 3.2% (TSA; p=0.07); reinterventions were more frequent in the EP group. Overall survival was comparable.

CONCLUSIONS

The rate of patients with poor indications due to non-neoplastic disease or advanced cancer is still high for both EP and TSA; multiple retreatments were necessary for EP. Although EP can be considered an appropriate primary therapy for certain ampullary adenomas, case selection for both therapies (especially with regard to the best step-up approach) should be studied further.

Relationship between intragastric meal distribution, gastric emptying and gastric neuromuscular dysfunction in chronic gastroduodenal disorders

Background

Chronic gastroduodenal symptoms arise from heterogenous gastric motor dysfunctions. This study applied multimodal physiological testing using gastric emptying scintigraphy (GES) with intragastric meal distribution (IMD) and Gastric Alimetry® body surface gastric mapping (BSGM) to define motility and symptom associations.

Methods

Patients with chronic gastroduodenal symptoms underwent simultaneous supine GES and BSGM with 30 m baseline, 99mTC-labelled egg meal, and 4 h postprandial recording. IMD (ratio of counts in the proximal half of the stomach to the total gastric counts) was calculated immediately after the meal (IMD0), with <0.568 defining impaired accommodation. BSGM phenotyping followed a consensus approach, based on normative spectral reference intervals.

Results

Among 67 patients (84% female, median age 40, median BMI 24), median IMD0 was 0.76 (IQR 0.69-0.86) with 5 (7.5%) meeting impaired accommodation criteria. Delayed gastric emptying (n=18) was associated with higher IMD0 (median 0.9 vs 0.7, p=0.004). On BSGM, 15 patients had abnormal spectrograms (5 [7.5%] high frequency and 10 (14.9%) low rhythm stability and/or amplitude); and in these patients, higher IMD0 (proximal retention) strongly correlated to delayed BSGM meal responses (R=-0.71, p=0.003). Lower IMD, indicating antral distribution, correlated with higher gastric frequencies (R=-0.27, p=0.03). BSGM abnormalities paired with impaired accommodation were associated with worse dyspeptic symptoms.

Conclusion

Proximal retention of food as assessed by intragastric meal distribution correlated with delayed emptying, and in the presence of neuromuscular spectral abnormalities (abnormal frequencies or rhythms), delayed motility responses on BSGM. Patients with multiple motor abnormalities experience worse dyspeptic symptoms.

Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study

BACKGROUND

Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making.

OBJECTIVE

This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States.

METHODS

We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors.

RESULTS

A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9% (n=2705) were health and wellness app users, while 19.1% (n=793) were nonusers. In the final adjusted model, participants with household incomes ≥US $50,000 had 49% higher adjusted odds of using these apps than those with incomes

CONCLUSIONS

Age, education, household income, and use of the internet are the major determinants of the adoption of digital health and wellness apps among seekers of cancer information. Hence, public health programs could be directed toward addressing these factors to improve cancer diagnosis, treatment, and management using these apps.

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Key Words

• United States
• adult
• barrier
• cancer information
• cancer intervention
• cancer management
• cancer screening
• cross-sectional study
• decision-making
• digital health
• digital health and wellness apps
• digital health engagement
• diversity
• engagement
• health seeking behavior
• knowledge seeking
• logistic regression
• mhealth
• mobile health
• mobile phone
• regression analysis
• telehealth
• utilization
• young adult

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MESH Headings

• Humans
• Cross-Sectional Studies
• Female
• Male
• Mobile Applications/statistics & numerical data
• Neoplasms/therapy
• Middle Aged
• Adult
• Aged
• Young Adult
• United States
• Adolescent
• Socioeconomic Factors

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Affiliation(s)

Ogochukwu Juliet Ezeigwe Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Kenechukwu Obumneme Samuel Nwosu Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Oladipo Kunle Afolayan Department of Biostatistics, The University of Texas Health Science Center, Houston, TX, United States
Akpevwe Amanda Ojaruega Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Jovita Echere Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Manali Desai Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Modupe Olajumoke Onigbogi Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States
Olajumoke Ope Oladoyin Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center, Houston, TX, United States
Nnenna Chioma Okoye Department of Pharmaceuticals, Gwarinpa General Hospital, Abuja, Nigeria
Pierre Fwelo Department of Epidemiology, The University of Texas Health Science Center, Houston, TX, United States

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Factors Affecting Negative Symptoms in Schizophrenia and Their Relationship with Anxiety and Depression

Objective

Negative symptoms significantly impair daily functioning and worsen clinical outcomes. Meanwhile, these symptoms are closely linked to anxiety and depression, further complicating prognosis. The mechanisms underlying these relationships remain unclear. This study aims to identify the factors influencing negative symptoms in schizophrenia and examine their relationship with anxiety and depression to guide more effective interventions and improve patient outcomes.

Methods

This study recruited 300 inpatients with schizophrenia from October 2022 to May 2023. Sociodemographic data and clinical characteristics were collected via a self-designed questionnaire. Negative symptoms, depression, and anxiety were assessed using the SANS, HAMD, and HAMA scales, respectively.

Results

Multiple regression analysis indicated that familial support (β = -1.285, P = 0.005), friend support (β = -0.797, P = 0.032), sleep quality (β = 2.307, P < 0.001), anxiety (β = 0.264, P = 0.004), and depression (β = 0.324, P = 0.007) were the main factors influencing negative symptoms. After adjusting for the duration of psychiatric disorder and type of antipsychotic medication as covariates, the above factors remained primary contributors to negative symptoms.

Conclusion

Enhancing familial support, friend support, and addressing emotional health and sleep disturbances are strategies that may alleviate negative symptoms in patients with schizophrenia.

The Rehabilitation of Partially Edentulous Maxilla With Unilateral Zygomatic Implants: A Retrospective Study up to 23 Years Follow-Up

OBJECTIVES

This retrospective study aimed to evaluate the clinical outcomes associated with zygomatic implant (ZI) rehabilitation in partially atrophic edentulous maxillae over a mean follow-up period of more than 10.3 years.

METHODS

All consecutive patients underwent ZI rehabilitation between 1999 and 2020, with a minimum follow-up period of 3 years. The primary outcome was the implant survaival rate. Secondary outcomes included the prosthesis success rate, complications, and Oral Health-Related Quality of Life.

RESULTS

Of the 21 patients, treated with 27 ZIs and 48 conventional implants (CIs), 9 (42.9%) were females. The mean follow-up was 10.3 ± 5.7 years (range 3.2-23.4). ZI and CI survival rates were 100% and 97.9%, respectively, with one CI that failed. Eleven patients received 12 CIs placed in the pterygoid and tuberosity region. Most of the implants (81.33%) were immediately loaded, with 17 patients (80.9%) receiving 21 acrylic bridges. Of the total of 26 definitive prosthesis, the success rate was 96.1%. Local inflammation (n = 2) and soft tissue recession (n = 1) were reported as complications, occurring at a mean follow-up of 4.5 and 3.2 years, respectively. The mean score of the OHIP-14 questionnaire was 1.19 ± 1.99.

CONCLUSIONS

Unilateral ZI rehabilitation was a predictable option for patients with partially atrophic edentulous maxilla who have experienced previous graft or implant failures, or who require immediate loading. Splinting the ZI with CI for restoration appeared to be essential in unilateral ZI treatment. Complications were infrequent and could be managed effectively, with patient-reported outcomes indicating normalization in quality of life.

Obesity correlates to the microsatellite instability of endometrial cancer: A retrospective observational study

OBJECTIVE

To investigate the relationship between obesity and Microsatellite Instability (MSI) in endometrial cancer (EC), determine which mismatch repair (MMR) protein loss is influenced by obesity, and assess the correlation between BMI and MSI probability.

METHODS

This retrospective cohort study included 89 endometrial cancer patients treated at the Gynaecologic oncology unit of the University of Campania "Luigi Vanvitelli" from August 2023 to October 2024, and stratified by BMI: normal weight (n = 26), overweight (n = 31), obese (n = 26), and severely obese (n = 6). Microsatellite instability (MSI) was determined through immunohistochemical assessment of mismatch repair (MMR) protein expression: MLH1, PMS2, MSH2, and MSH6. Tumors were considered MSI if at least one of the four MMR proteins showed loss of expression. Univariate and multivariate logistic regression models were constructed to evaluate the correlation between BMI and MSI RESULTS: 89 patients were enrolled. Obese and severely obese groups showed significantly higher MSI rates (50 % each) compared to normoweight (12 %) and overweight (29 %) groups (P = .013). MLH1 and PMS2 loss of expression were significantly higher in obese and severely obese women (MLH1: P = .003; PMS2: P = .014). Univariate logistic regression showed a significant positive correlation between BMI and MSI (OR 1.02, 95 % CI 1.01-1.04, P = .007). In multivariate analysis, adjusting for grading, stage, histotype, and age, BMI maintained a significant positive correlation with MSI (OR 1.02, 95 % CI 1.01-1.04, P = .048).

CONCLUSIONS

This study demonstrates a significant association between obesity and MSI in EC, particularly affecting MLH1 and PMS2 expression. The findings suggest that obesity may contribute to EC development also through MMR deficiency.

Informal caregivers' roles and needs regarding shared decision-making in severe aortic stenosis

OBJECTIVE

To provide insight into experiences, preferences and needs of informal caregivers (ICs) regarding shared decision-making (SDM) in severe aortic stenosis (AS) of patients ≥ 70 years, and the effect of the level of perceived SDM on ICs' quality of life (QOL) and distress.

METHODS

Multiple methods study consisting of a questionnaire at baseline and 3-month follow-up and focus groups.

RESULTS

Ninety-nine ICs (67.6 ± 11.7 years) completed the baseline questionnaire, eighty-two ICs the follow-up questionnaire, ten ICs (70.6 ± 12.6 years) participated in two focus groups. ICs perceived that identifying them as discussion partners and addressing patients' daily lives were least discussed with professionals (26.3 %; 59.6 %). Most ICs (63.9 %) preferred a collaborative decision-making (DM) role. The level of perceived SDM was positively associated with baseline QOL social relations (p = .038), and follow-up QOL psychological health (p = .048) and environment (p = .024). ICs experienced three roles in SDM: supporters in DM, stimulators in clarifying patient's personal context, and DM partners.

CONCLUSION

ICs play valuable roles in SDM for severe AS, but feel professionals do not consistently identify them as discussion partners.

PRACTICE IMPLICATIONS

Professionals should involve ICs in SDM for discussing older patient's QOL and personal context, which can inform personalized decisions regarding severe AS treatment.