The state of US health, 1990-2010: burden of diseases, injuries, and risk factors

A Tai chi and qigong mind-body program for low back pain: A virtually delivered randomized control trial

Background

Mind-body treatments have the potential to manage pain, yet their effectiveness when delivered online for the treatment of low back pain (LBP) is unknown. We sought to evaluate whether a virtually delivered mind-body program integrating tai chi, qigong, and meditation (VDTQM) is effective for treating LBP.

Methods

This randomized controlled trial compared VDTQM (n=175) to waitlist control (n=175). Eligible participants were at least 18 years old, had LBP for at least 6 weeks, were not pregnant, had not previously taken tai chi classes, and had not undergone spine surgery within 6 months. The treatment group received a 12-week VDTQM program in live online 60-minute twice-weekly group classes from September 2022 to December 2022. All participants continued their usual activities and care. Primary outcome was pain-related disability assessed by the Oswestry Disability Index (ODI) score. Secondary outcomes included pain intensity, sleep quality, and quality of life (QOL). Intent-to-treat analyses were conducted.

Results

Of the 350 participants 278 (79%) were female, mean age was 58.8 years (range: 21-92), 244 (69.7%) completed the 8-week survey, 248 (70.9%) the 12-week, and 238 (68%) the 16 -week. No participants withdrew due to adverse treatment effects. Compared with control group, treatment group experienced statistically and clinically significant improvement in ODI score by -4.7 (95% CI: -6.24 to -3.16, p<.01), -6.42 (95% CI: -7.96 to -4.88, p<.01), and -8.14 (95% CI: -9.68 to -6.59, p<.01) points at weeks 8, 12, and 16, respectively. Treatment group also experienced statistically significant improvement at all time points in the other outcomes.

Conclusions

Among adults with LBP, VDTQM treatment resulted in small to moderate improvements in pain-related disability, pain intensity, sleep quality, and QOL. Improvements persisted 1 month after treatment concluded. These findings suggest VDTQM may be a viable treatment option for patients with LBP.Trial registration: clincaltrials.gov Identifier: NCT05801588.

Serum Soluble Receptors for Advanced Glycation End-Products May Predict Mortality in Microscopic Polyangiitis and Granulomatosis with Polyangiitis

PURPOSE

This study aimed to investigate whether the serum extracellular newly identified receptor for advanced glycation end products binding protein (EN-RAGE) and the soluble form of RAGE (sRAGE) measured at diagnosis are associated with all-cause mortality in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA).

MATERIALS AND METHODS

Serum EN-RAGE and sRAGE were measured in 75 immunosuppressive drug-naïve MPA and GPA patients using an immunoassay, with their clinical and laboratory data reviewed. The optimal cut-off point of EN-RAGE and sRAGE was calculated by finding the threshold with the maximum sum of sensitivity and specificity. In addition, the least absolute shrinkage and selection operator regression was adopted to select variables included in the multivariable Cox proportional hazards (PH) regression model.

RESULTS

The median age of the patients was 67.0 years, and 34% were male. Neither serum EN-RAGE nor sRAGE at diagnosis was correlated with the Birmingham Vasculitis Activity Score. Furthermore, no correlation was observed between serum EN-RAGE and sRAGE. Deceased patients had significantly lower serum EN-RAGE and higher serum sRAGE at diagnosis compared to surviving patients. Patients with serum EN-RAGE at diagnosis ≤84.37 ng/mL and serum sRAGE at diagnosis ≥1.82 ng/mL showed significantly lower survival probabilities compared to those without. In multivariable Cox PH regression model, only serum sRAGE at diagnosis ≥1.82 ng/mL, rather than serum EN-RAGE at diagnosis ≤84.37 ng/mL, was independently associated with all-cause mortality (hazard ratio 7.094).

CONCLUSION

This study is the first to demonstrate that serum sRAGE at diagnosis may independently predict all-cause mortality during follow-up in patients with MPA and GPA.

Metabolic Syndrome and Socioeconomic Status in Association with Chronic Kidney Disease: A Cross-Sectional Study in Ningbo, China

Background

Metabolic syndrome (MS) and low socioeconomic status (SES) may increase the risk for chronic kidney disease (CKD). This study aimed to investigate the prevalence of MS and CKD and the association between MS, SES, and CKD among adults in Ningbo, a city in Eastern China.

Methods

A cross-sectional survey of 3212 adults was conducted between July 2019 and February 2021 in Ningbo. MS was defined as the presence of three or more risk factors: elevated blood pressure, reduced high-density lipoprotein (HDL) cholesterol, elevated triglycerides, elevated plasma glucose, and abdominal obesity. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or the occurrence of albuminuria. SES was stratified according to personal education and income levels. Multivariate logistic regression was used to analyze the relationships among MS, sociodemographic factors, and CKD.

Results

The age- and sex-adjusted prevalence of CKD was 9.1% (95% CI: 8.3-10.0), the prevalence of eGFR less than 60 mL/min/per 1·73 m² was 2.5% (95% CI 2.0-3.0) and that of albuminuria was 7.9% (95% CI 7.0-8.7), and the adjusted prevalence of MS was 23.1% (95% CI 21.7-24.4). MS components, including elevated blood pressure, elevated fasting glucose, abdominal obesity, elevated serum triglyceride, or reduced serum HDL-C, were independent risk factors for CKD, and the adjusted prevalence of CKD proportionally increased with the number of MS-defined parameters. Participants with MS had 2.43-fold increased odds of developing CKD compared with those without MS. In addition, age, female sex, low SES including low educational level and low income were associated with increased odds of occurrence of albuminuria and CKD.

Conclusion

The prevalence of metabolic syndrome and chronic kidney disease is high among adults in Ningbo. Metabolic syndrome and low socioeconomic status are associated with the high risk of developing chronic kidney disease.

The relationships between resilience and child health behaviors in a national dataset

BACKGROUND

Resilience mechanisms at the individual, family, and environmental levels may improve health outcomes despite potentially harmful stress exposure partly through the practice of positive health behaviors.

METHODS

We performed a secondary analysis of 2016-2021 National Survey of Children's Health data to assess the relationships between three resilience domains - child, family, neighborhood - and six health behaviors using multiple regression models adjusted for the other resilience domain(s) and potential confounders.

RESULTS

Analysis revealed significant associations between each resilience domain and multiple health behaviors in a total weighted analytic sample of 70,156,540 children. For each outcome, the odds of better health behaviors were highest with high resilience in all possible domains. For example, among children ages 0-5 years, the adjusted odds of having "good quality" vs. "poor quality" sleep for those with "high" resilience in all domains were 2.21 times higher (95% CI 1.78, 2.63) than for those with "low" resilience in all domains.

CONCLUSIONS

This line of research may help to inform the design of resilience and health behavior promotion interventions by targeting multiple socio-ecological domains of influence to improve health and development outcomes in children exposed to experiences or sources of potential stress.

IMPACT

This study assessed the associations between three socio-ecological resilience domains (child, family, and neighborhood) and six child and family health behaviors in a national dataset. Resilience exists within multiple socio-ecological levels and supports healthy functioning despite experiencing stress. Studies in adults and limited pediatric sub-populations show associations between resilience and health behaviors, which in turn influence numerous health outcomes. Resilience at three levels of socio-ecological levels was found to be associated with the performance of multiple child and family health behaviors in a nationally representative general pediatric population. These findings have important implications for child and family health promotion efforts.

Adjunctive cariprazine for the treatment of major depressive disorder: Number needed to treat, number needed to harm, and likelihood to be helped or harmed

BACKGROUND

The number needed to treat (NNT) for efficacy and number needed to harm (NNH) for tolerability/safety were evaluated for adjunctive cariprazine in major depressive disorder (MDD).

METHODS

Data were extracted from five randomized, double-blind, placebo-controlled trials of adjunctive cariprazine in MDD. NNTs (response, remission, severity shift) and NNHs (discontinuations due to adverse events [AEs], AEs, laboratory shifts) were determined in dose groupings; likelihood to be helped/harmed (LHH) was calculated.

RESULTS

NNTs (95 % CI) for adjunctive cariprazine versus placebo were statistically significant at week 6/early termination for Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≥ 50 % response (doses ≥1 mg/d = 12 [9-21]; 1-2 mg/d = 12 [8-25]; 2-4.5 mg/d = 14 [9-43]) and other response/remission outcomes. NNHs for cariprazine versus placebo were generally ≥10 for AEs that were statistically significant; an apparent dose-response was seen for akathisia (lower dose = 24 [17-43]; higher dose = 9 [7-11]). LHHs were ≥ 1 (acceptable benefit/harm ratio) for MADRS total score response versus most important cariprazine AEs in most dose groupings. For response versus discontinuation because of an AE, adjunctive cariprazine 1-2 mg/d had a more favorable response/tolerability profile in indirect comparison with other approved atypical antipsychotics.

LIMITATIONS

Post hoc analysis; indirect comparisons.

CONCLUSIONS

Patients receiving adjunctive cariprazine encountered benefits more often than harm; NNT values at week 6/ET were statistically significant versus placebo on response/remission outcomes across dose groupings from the 5 pooled studies. Adjunctive cariprazine was well tolerated; NNH values versus placebo were generally >10, with better akathisia tolerability in the lower-dose range.

Allura Red AC is a xenobiotic. Is it also a carcinogen?

Merriam-Webster and Oxford define a xenobiotic as any substance foreign to living systems. Allura Red AC (a.k.a., E129; FD&C Red No. 40), a synthetic food dye extensively used in manufacturing ultra-processed foods and therefore highly prevalent in our food supply, falls under this category. The surge in synthetic food dye consumption during the 70s and 80s was followed by an epidemic of metabolic diseases and the emergence of early-onset colorectal cancer in the 1990s. This temporal association raises significant concerns, particularly given the widespread inclusion of synthetic food dyes in ultra-processed products, notably those marketed toward children. Given its interactions with key contributors to colorectal carcinogenesis such as inflammatory mediators, the microbiome, and DNA damage, there is growing interest in understanding Allura Red AC's potential impact on colon health as a putative carcinogen. This review discusses the history of Allura Red AC, current research on its effects on the colon and rectum, potential mechanisms underlying its impact on colon health, and provides future considerations. Indeed, although no governing agencies classify Allura Red AC as a carcinogen, its interaction with key guardians of carcinogenesis makes it suspect and worthy of further molecular investigation. The goal of this review is to inspire research into the impact of synthetic food dyes on colon health.

Multiscale-temporal Feature Extraction and boundary confusion alleviation for VAG-based fine-grained multi-grade osteoarthritis deterioration monitoring

BACKGROUND AND OBJECTIVE

Multi-grade osteoarthritis (OA) deterioration monitoring in the daily paradigm using Vibroarthrography (VAG) is very challenging due to two difficulties: (1) the composition of VAG signals is complex in the daily paradigm where friction is intensified because of weight-bearing movements. (2) VAG signal samples near the decision boundary of adjacent deterioration grades are easy to be misclassified. The majority of existing works only focus on the binary classification of OA, providing inadequate assistance in instructing physicians to develop treatment plans based on the presence or absence of OA. Thus, we propose a novel framework for fine-grained multi-grade OA deterioration monitoring in the daily paradigm.

METHODS

We propose an end-to-end deep learning framework termed Fine-grained Multi-grade OA Deterioration Monitor (FMOADM), which consists of Multiscale-temporal Feature Extraction (MTFE) and Confusion-Free Master-Slave (CF-MS) Classification. Specifically, MTFE is adopted to extract multiscale-temporal discriminative features from the complicated VAG signals. And center loss is introduced by CF-MS to alleviate confusion at the boundary of adjacent deterioration grades in the feature space. Meanwhile, a master-slave structure is proposed for further fine-grained classification, where the master classifier integrates a channel attention mechanism and the slave classifier is designed to update MTFE parameters. As a result, the proposed method ensures fine-grained multi-grade OA monitoring performance via multiscale-temporal discriminative features and boundary confusion alleviation.

RESULTS

Experimental results on the VAG-OA dataset demonstrate that our framework outperforms counterpart methods in the daily paradigm. The proposed framework achieved 78% in precision, obtaining an 8% improvement over the state-of-the-art method.

CONCLUSION

The proposed framework benefits efficient multi-grade OA deterioration monitoring, empowering physicians to develop treatment plans based on fine-grained monitoring results. It takes knee joint health monitoring in daily activities a step further toward feasible.

Disability terminology: the use of "disability," "disorder," and "illness" in academic writing

PURPOSE

The ways in which words are used to describe and discuss people with disabilities has long been an area of social concern. Previous research has demonstrated that language can overtly and subtly influence cognitions and perceptions of individuals, but there is less research on how language relates to perceptions of individuals with disabilities.

MATERIALS AND METHODS

A content analysis of 236 peer-reviewed articles was performed to explore differences in the frequency of the use of "disability," "disorder," and "illness" in academic articles related to eight common conditions: deafness, blindness, multiple sclerosis, quadriplegia, anxiety, depression, schizophrenia, and addiction.

RESULTS

Results indicated that there were differences in how disability language was used by academic writers. Specifically, "disability" appeared in the writing more frequently in articles related to physical disabilities, "disorder" appeared most frequently in articles related to anxiety and depression, and "illness" appeared most frequently in articles related to schizophrenia.

CONCLUSIONS

This observed difference in frequency use could reflect differences in the context and meaning of the use of these conditions. Suggestions for future research are discussed.

Pain intensity scales: A cross-sectional study on the preferences and knowledge of physiotherapists and participants with musculoskeletal pain

BACKGROUND

Subjective pain intensity can be measured using instruments like the Faces Pain Scale-Revised (FPS-R), Verbal Rating Scale (VRS), Numerical Pain Rating Scale (NPRS), and Visual Analogue Scale (VAS). However, information on physiotherapists' and patients' knowledge and preference for these tools is scarce.

OBJECTIVE

We investigated the knowledge and preference of physiotherapists and participants with musculoskeletal pain (MP) regarding the pain intensity measurement scales.

METHODS

This cross-sectional study consisted of physiotherapists and participants with MP. Physiotherapists were recruited via social media for an online open survey, gathering sociodemographic, professional data, and their knowledge and preferences for pain intensity scales. Participants over 18 with MP, participated in interviews focusing on their familiarity and preferences for pain intensity scales. Data was analyzed descriptively, and Chi-squared test evaluated scale preferences.

RESULTS

We included 352 physiotherapists (mean experience = 10.5 years) and 94 participants with MP. Of the physiotherapists, 94.3% were familiar with pain scales, but 30.4% struggled to differentiate them. The NPRS was the most used (56.3%) and preferred scale (52.4%). Among participants with MP, unfamiliarity was noted with all scales. After instruction, 46% preferred FPS-R, with preference varying by income and education levels (p < 0.001).

CONCLUSION

We found a knowledge gap among physiotherapists in identifying pain intensity scales, with a preference for the NPRS among those familiar with the scales. Participants with MP had limited familiarity with these scales. After instructions, these participants preferred the FPS-R, particularly those with lower income and education levels.

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study

BACKGROUND

Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting.

OBJECTIVE

This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany.

METHODS

The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy.

RESULTS

The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024.

CONCLUSIONS

This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/58089.

Severity of lumbar spinal stenosis does not impact responsiveness to exercise-based rehabilitation

Spine pain is a prevalent and costly condition affecting up to 85% of individuals throughout their lifetime, and spinal stenosis is one of the most debilitating sources of spine pain. Although conservative management is the first line of treatment for spinal stenosis, severe cases often are directly referred to surgical intervention due to the belief that conservative strategies delay necessary treatment. However, there are no studies supporting the premise that individuals with more severe stenosis respond poorly to conservative management. The purpose of this study was to compare improvements in pain, disability, strength, medication usage, and patient goals in response to an exercise-based physical therapy program across 1,806 individuals with mild, moderate, or severe lumbar spine stenosis. Participants demonstrated significant improvements in all variables of interest (p<0.001), and 11.5% of participants reported cessation of narcotic use with treatment. There were no significant differences in treatment response across mild, moderate, or severe stenosis groups for any outcome (p>0.546). Exercise-based rehabilitation is as beneficial in the short term for individuals presenting for nonoperative care with severe stenosis compared to their milder counterparts. Future research is needed to evaluate long term durability and cost effectiveness of rehabilitation in this patient population.

Prevalence of musculoskeletal pain among undergraduate students

Introduction

Musculoskeletal disorders (MSDs) are rapidly rising in Saudi Arabia, reaching levels similar to those in the Western world. Hence, we aimed to assess the prevalence of neck, shoulder, and lower back pains (musculoskeletal pain, MSP) among students at King Khalid University in Abha, Saudi Arabia.

Methods

This cross-sectional study was conducted at King Khalid University in Abha, Saudi Arabia, from March 2023 to August 2023. Inclusion criteria were: university students aged 18 years and older of both sexes who agreed to participate in the study. The modified Nordic questionnaire was used, which comprised three parts.

Results

Out of 536 respondents, 337 were women and 199 were men. The average body mass index (BMI) of the study population was 25.3 ± 4.01. In total, 223 (41.60%) had a history of MSDs. Only 232 (43.28%) of the population did regular exercise. According to multiple logistic regression analysis, factors associated with MSDs are mobile device use (with both hands) with a large neck tilt below the horizon line position (OR = 2.276, CI 1.178-4.397, p = 0.014), family history of trauma (OR = 5.450, 95% CI 3.371-8.811, p = 0.000), family history of MSDs (OR = 4.241, 95% CI 2.296-7.835, p = 0.000), coffee consumption (OR = 1.967, CI 1.281-3.020, p = 0.002), and time spent on electronic devices: 1-3 h (OR = 0.252, 95% CI 0.124-0.511, p = 0.0001), 4-6 h (OR = 0.455, 95% CI 0.237-0.873, p = 0.018), and 6-9 h (OR = 0.348, 95% CI 0.184-0.660, p = 0.001).

Conclusion

The present study concludes that MSP among university students is high. A history of trauma, a family history of MSDs, the hand and neck position when using electronic devices, the amount of time spent using them, and regular exercise are risk factors that are strongly associated with MSP. There is strong evidence to suggest that increasing physical activity plays a significant role in enhancing the functionality of the musculoskeletal (MSK) system and alleviating pain. It is recommended that universities implement educational programs to raise awareness and health screenings about the impact of device usage on MSK health and the benefits of regular exercise.

Serum syndecan1 has the potential to reflect activity at diagnosis and predict death during follow-up in patients with ANCA-associated vasculitis

OBJECTIVES

This study investigated whether serum syndecan1 at diagnosis reflects activity at diagnosis and predicts poor outcomes during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

METHODS

The study included 79 patients with AAV from the cohort of Korean patients diagnosed with AAV. AAV-specific indices, including the Birmingham vasculitis activity score (BVAS), five-factor score (FFS), 36-item short-form survey (SF-36) physical and mental component summary (PCS and MCS), and vasculitis damage index (VDI), were assessed. Laboratory data including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also collected. The highest tertile and upper half of the BVAS were tentatively defined as having high AAV activity. Serum syndecan1 levels were measured in sera stored at diagnosis.

RESULTS

Serum syndecan1 at diagnosis was significantly correlated with AAV activity and functional status, as assessed by BVAS, FFS, SF-36 PCS, MCS, and acute-phase reactants, including ESR and CRP. Patients with serum syndecan1 ≥ 76.1 ng/mL at diagnosis, and those with serum syndecan1 ≥ 60.0 ng/mL at diagnosis showed significantly higher risks for the highest tertile and the upper half of BVAS at diagnosis than those without, respectively. Patients with serum syndecan1 ≥ 120.1 ng/mL at diagnosis had a significantly higher risk for all-cause mortality during follow-up than those without, and further, exhibited a significantly lower cumulative patients' survival rate than those without.

CONCLUSION

Serum syndecan1 at diagnosis may not only reflect AAV activity at diagnosis but may also be associated with all-cause mortality during follow-up.

Open-Label Placebo Injection for Chronic Back Pain With Functional Neuroimaging: A Randomized Clinical Trial

Importance

Chronic back pain (CBP) is a leading cause of disability. Placebo treatments often provide as much pain relief as bona fide treatments, such as steroid injections. Open-label (honestly prescribed) placebos (OLPs) may relieve CBP without deception, but OLP mechanisms remain poorly understood.

Objective

To investigate the long-term efficacy and neurobiological mechanisms of OLP for CBP.

Design, Setting, and Participants

A randomized clinical trial of CBP with longitudinal functional magnetic resonance imaging (MRI) comparing OLP with usual care, with 1-year follow-up, was conducted in a university research setting and a community orthopedic clinic. Participants were individuals aged 21 to 70 years with CBP. The trial was conducted from November 2017 to August 2018, with 1-year follow-up completed by November 2019. Data analysis was performed from April 2020 to May 2024. The primary analysis was conducted on an intention-to-treat sample.

Interventions

Participants randomized to OLP received a 1-time subcutaneous lumbar saline injection presented as placebo accompanied by information about the power of placebo to relieve pain, alongside their ongoing care. Usual care participants continued their ongoing care.

Main Outcomes and Measures

The primary outcome was pain intensity (0-10, with 0 indicating no pain and 10 the most intense) at 1 month posttreatment. Secondary outcomes included pain interference, depression, anxiety, anger, and sleep quality. Functional MRI was performed before and after treatment during evoked and spontaneous back pain.

Results

A total of 101 adults (52 [51.4%] females; mean [SD] age, 40.4 [15.4] years) with moderate severity CBP (mean [SD], 4.10 [1.25] intensity; duration, 9.7 [8.5] years) were enrolled. Compared with usual care, OLP reduced CBP intensity posttreatment (relative reduction, 0.61; Hedges g = 0.45; 95% CI, -0.89 to 0.04; P = .02). Through 1-year follow-up, pain relief did not persist, although significant benefits were observed for depression, anger, anxiety, and sleep disruption (Hedges g = 0.3-0.5; all P < .03). Brain responses to evoked back pain for OLP vs usual care increased in rostral anterior cingulate and ventromedial prefrontal cortex and decreased in somatomotor cortices and thalamus. During spontaneous pain, functional connectivity analyses identified OLP vs usual care increases in ventromedial prefrontal cortex connectivity to the rostral ventral medulla, a pain-modulatory brainstem nucleus. No adverse effects of treatment were reported by participants.

Conclusions and Relevance

In this randomized clinical trial of OLP vs usual care, a single nondeceptive placebo injection reduced CBP intensity for 1 month posttreatment and provided benefits lasting for at least 1 year posttreatment. Brain mechanisms of OLP in a clinical population overlap with those of deceptive placebos in healthy volunteers, including engagement of prefrontal-brainstem pain modulatory pathways.

Trial Registration

ClinicalTrials.gov Identifier: NCT03294148.

Assessing suicide risk in chronic pain management: a narrative review across drug classes

INTRODUCTION

Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk.

AREAS COVERED

This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions.

EXPERT OPINION

While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.

Is There a Change in Anxiety and Depression Following Total Knee Arthroplasty?

BACKGROUND

The primary purpose of this study was to investigate whether anxiety and depression change following total knee arthroplasty (TKA). A secondary objective was to explore the association between preoperative variables and changes in anxiety and depression.

METHODS

This was a prospective, multicenter, cohort study. Participants (n = 1,852, age 64 ± 8.7 years, a body mass index of 31.3, a modified Comorbidity Index of 1.0 ± 1.3, and 61.7% were women) completed the EuroQol 5-dimension 5-level preoperatively and at 1- and 3-month postoperatively. Fulfillment of physical activity expectations and preparedness to resume activities was assessed at 3 months. The anxiety or depression dimension was analyzed using the Paretian classification profile changes and compared with the sign Fisher's exact test. Logistic regressions were used to analyze the relationship between patient characteristics, preoperative anxiety or depression, activity expectations, preparedness to resume activities, and changes in anxiety/depression.

RESULTS

The percentage of patients reporting Level 1 (no anxious or depressed feelings) significantly (P < .0001) increased from preoperative (62.2%) to 3 months (77.1%) postoperative, while levels 2 to 5 (slightly through extremely anxious or depressed) all decreased. The percentage of worsening anxiety and depression was significantly (P < .0001) greater in patients who did not feel they were well prepared to resume activities of daily living (17.7 versus 4.4%) and physical recreation (12.9 versus 3.9%). Preoperative anxiety and depression (odds ratio [OR] 52.27, 95% confidence interval [CI]: 34.98, 80.67), EuroQol 5-dimension 5-level (OR: 2.55, 95% CI: 1.04, 6.34), activity of daily living (OR: 1.57, 95% CI: 1.19, 2.06), and body mass index (OR: 1.05, 95% CI: 1.02, 1.08) were significant (P < .05) predictors of an improving Paretian change profile at 3 months postoperative.

CONCLUSIONS

Anxiety and depression decrease following TKA, and these changes appear heavily dependent on a patient's preoperative psychological well-being and postoperative preparedness to resume daily activities. Physicians' awareness of preoperative patient psychological well-being and management of patient preparedness and expectations to resume physical activity may modulate postoperative anxiety and depression.

Hungry for relief: Potential for neurotensin to address comorbid obesity and pain

Chronic pain and obesity frequently occur together. An ideal therapy would alleviate pain without weight gain, and most optimally, could promote weight loss. The neuropeptide neurotensin (Nts) has been separately implicated in reducing weight and pain but could it be a common actionable target for both pain and obesity? Here we review the current knowledge of Nts signaling via its receptors in modulating body weight and pain processing. Evaluating the mechanism by which Nts impacts ingestive behavior, body weight, and analgesia has potential to identify common physiologic mechanisms underlying weight and pain comorbidities, and whether Nts may be common actionable targets for both.

Spontaneous Bacterial Peritonitis: A Rare Incidence by Achromobacter xylosidans

Liver cirrhosis results from progressive hepatic fibrosis and is generally considered irreversible. One of the many consequences of cirrhosis is spontaneous bacterial peritonitis. This typically presents in patients with decompensated cirrhosis due to bacterial translocation, most commonly from the intestinal bacterial flora seeding into the ascitic fluid. We present a rare case of spontaneous bacterial peritonitis caused by Achromobacter xylosidans. This bacterium is mostly associated with nosocomial infections, and due to its multidrug-resistant nature, treatment options are often limited. This case highlights a rare cause of spontaneous bacterial peritonitis to consider in the setting of recent hospitalization, and the importance of recognizing spontaneous bacterial peritonitis versus secondary bacterial peritonitis.

Interventions for Integrating Behavioral Health into HIV Settings for US Adults: A Narrative Review of Systematic Reviews and Meta-analyses, 2010-2020

Mental health and substance use disorders can negatively affect physical health, illness management, care access, and quality of life. These behavioral health conditions are prevalent and undertreated among people with HIV and may worsen outcomes along the entire HIV Care Continuum. This narrative review of tested interventions for integrating care for HIV and behavioral health disorders summarizes and contextualizes findings from systematic reviews and meta-analyses conducted in the past decade. We sought to identify gaps in research that hinder implementing evidence-based integrated care approaches. Using terms from the Substance Abuse and Mental Health Services Administration-Health Resources & Services Administration standard framework for integrated health care, we searched PubMed and PsycInfo to identify peer-reviewed systematic reviews or meta-analyses of intervention studies to integrate behavioral health and HIV published between 2010 and 2020. Among 23 studies identified, only reviews and meta-analyses that described interventions from the United States designed to integrate BH services into HIV settings for adults were retained, leaving six studies for narrative review by the study team. Demonstrated benefits from the relatively small literature on integrated care interventions include improved patient- and service-level outcomes, particularly for in-person case management and outreach interventions. Needed are systems-level integration interventions with assessments of long-term outcomes on behavioral health symptoms, HIV viral suppression, HIV transmission rates, and mortality. HIV, primary care, and other providers must include behavioral health as a part of overall healthcare and must play a central role in behavioral health care delivery. Research is needed to guide their way.

Pains Revisited

OBJECTIVES

The management of pain patients has not evolved as rapidly as envisioned when IASP was founded almost 50 years ago. We sought to identify factors that could contribute to this situation, with a focus on concepts of pain and the education of pain physicians.

METHODS

Relevant literature describing new strategies for diagnosing and managing patients with high-impact chronic pain was reviewed.

RESULTS

It appears that the acute-chronic dichotomy has outlived its usefulness and pains should be identified as of peripheral origin or due to central processing errors. Pains of peripheral origin and those of central processing errors require different diagnostic and therapeutic strategies.

DISCUSSION

Peripheral treatments and opioids are not effective for central pains. When the cause of the pain lies in the central nervous system, a more centrally focused approach is needed to minimize wasteful pursuit of peripheral causes. The education and training of pain physicians should reflect the skills needed to address these 2 very different clinical problems.

Physical Therapy for Muscle Tension Dysphonia with Cervicalgia

OBJECTIVES

This study investigated the effectiveness of a specialized manual physical therapy (PT) program at improving voice among patients diagnosed with concomitant muscle tension dysphonia (MTD) and cervicalgia at a tertiary care voice center.

MATERIALS AND METHODS

Cervicalgia was determined by palpation of the anterior neck. Both voice therapy (VT) and PT was recommended for all patients diagnosed with MTD and cervicalgia. PT included full-body manual physical therapy with myofascial release. Patients underwent: 1) VT alone, 2) concurrent PT and VT (PT with VT), 3) PT alone, 4) VT, but did not have PT ordered by treating clinician (VT without PT order) or 5) VT followed by PT (VT then PT). The pairwise difference in post-Voice Handicap Index-10 (VHI-10) controlling for baseline variables was calculated with a linear regression model.

RESULTS

178 patients met criteria. All groups showed improvement with treatment. The covariate-adjusted differences in mean post-VHI-10 improvement comparing the VT alone group as a reference were as follows: PT with VT 9.95 (95% confidence interval 7.70, 12.20); PT alone 8.31 (6.16, 10.45); VT without PT order 8.51 (5.55, 11.47); VT then PT 5.47 (2.51, 8.42).

CONCLUSION

Among patients diagnosed with MTD with cervicalgia, treatment with a specialized PT program was associated with improvement in VHI-10 scores regardless of whether they had VT. While VT is the standard of care for MTD, PT may also offer benefit for MTD patients with cervicalgia.

Exploring the bidirectional causal associations between pain and circulating inflammatory proteins: A Mendelian randomization study

Multisite chronic pain (MCP) and site-specific chronic pain (SSCP) may be influenced by circulating inflammatory proteins, but the causal relationship remains unknown. To overcome this limitation, two-sample bidirectional Mendelian randomization (MR) analysis was used to analyse data for 91 circulating inflammatory proteins, MCP and SSCP encompassing headache, back pain, shoulder pain, hip pain, knee pain, stomach abdominal pain and facial pain. The primary MR method used was inverse variance weighting, sensitivity analyses included weighted median, MR pleiotropy residual sum and outlier and the Egger intercept method. Heterogeneity was also detected using Cochrane's Q test and leave-one-out analyses. Finally, a causal relationship between 29 circulating inflammatory proteins and chronic pain was identified. Among these proteins, 14 exhibited a protective effect, including MCP (T-cell surface glycoprotein cluster of differentiation 5), headache (4E-binding protein 1 [4EBP1], cluster of differentiation 40, cluster of differentiation 6 and C-X-C motif chemokine [CXCL] 11), back pain (leukaemia inhibitory factor), shoulder pain (fibroblast growth factor [FGF]-5 and interleukin [IL]-18R1), stomach abdominal pain (tumour necrosis factor [TNF]-α), hip pain (CXCL1, IL-20 and signalling lymphocytic activation molecule 1) and knee pain (IL-7 and TNF-β). Additionally, 15 proteins were identified as risk factors for MCP and SSCP: MCP (colony-stimulating factor 1, human glial cell line-derived neurotrophic factor and IL-17C), headache (fms-related tyrosine kinase 3 ligand, IL-20 receptor subunit α [IL-20RA], neurotrophin-3 and tumour necrosis factor receptor superfamily member 9), facial pain (CXCL1), back pain (TNF), shoulder pain (IL-17C and matrix metalloproteinase-10), stomach abdominal pain (IL-20RA), hip pain (C-C motif chemokine 11/eotaxin-1 and tumour necrosis factor ligand superfamily member 12) and knee pain (4EBP1). Importantly, in the opposite direction, MCP and SSCP did not exhibit a significant causal impact on circulating inflammatory proteins. Our study identified potential causal influences of various circulating inflammatory proteins on MCP and SSCP and provided promising treatments for the clinical management of MCP and SSCP.

Epigenetic Landscapes of Pain: DNA Methylation Dynamics in Chronic Pain

Chronic pain is a prevalent condition with a multifaceted pathogenesis, where epigenetic modifications, particularly DNA methylation, might play an important role. This review delves into the intricate mechanisms by which DNA methylation and demethylation regulate genes associated with nociception and pain perception in nociceptive pathways. We explore the dynamic nature of these epigenetic processes, mediated by DNA methyltransferases (DNMTs) and ten-eleven translocation (TET) enzymes, which modulate the expression of pro- and anti-nociceptive genes. Aberrant DNA methylation profiles have been observed in patients with various chronic pain syndromes, correlating with hypersensitivity to painful stimuli, neuronal hyperexcitability, and inflammatory responses. Genome-wide analyses shed light on differentially methylated regions and genes that could serve as potential biomarkers for chronic pain in the epigenetic landscape. The transition from acute to chronic pain is marked by rapid DNA methylation reprogramming, suggesting its potential role in pain chronicity. This review highlights the importance of understanding the temporal dynamics of DNA methylation during this transition to develop targeted therapeutic interventions. Reversing pathological DNA methylation patterns through epigenetic therapies emerges as a promising strategy for pain management.

Depressive Disorder and Trimalleolar Fractures: An Analysis of Outcomes and Costs

INTRODUCTION

Studies have suggested a strong association between depression and poor outcomes following various orthopaedic surgeries. However, depression's impact on complications following open reduction/internal fixation (ORIF) of trimalleolar fractures has not been elucidated. Therefore, this study aimed to determine whether depression is associated with higher rates of readmissions and medical complications following ORIF of trimalleolar fractures.

METHODS

A database query from January, 2020, through March, 2021, identifying adults who underwent trimalleolar ORIF generated 50 154 patients. Those with depression were matched 1:1 to controls without depression by age, sex, chronic obstructive pulmonary disease, anxiety, and other prominent comorbidities. Primary endpoints compared 90-day all-cause readmissions and medical complications. Odds ratios (ORs) of the effect of depression on readmissions and medical complications were calculated.

RESULTS

Patients with depression who underwent ORIF of trimalleolar fractures had significantly higher odds of being readmitted within 90 days of the initial procedure (OR: 1.37; P < .0001). Ninety-day odds of developing medical complications were significantly higher (OR: 4.61; P < .0001) in patients with depression compared with patients within the control group.

CONCLUSION

Patients with depression undergoing trimalleolar ORIF face an increased risk of readmission and multiple postoperative complications. Orthopaedic surgeons should factor depression into their preoperative evaluation, given the already high burden of complications following ORIF of trimalleolar fractures.

LEVEL OF EVIDENCE

Level III: Retrospective cohort study.

Circulating Malondialdehyde Is a Potential Biomarker for Predicting All-Cause Mortality during Follow-Up by Reflecting Comprehensive Inflammation at Diagnosis in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Background and Objectives: To investigate whether circulating malondialdehyde (cMDA) at diagnosis could contribute to reflecting cross-sectional comprehensive inflammation or vasculitis activity and further predicting all-cause mortality during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Materials and Methods: This study included 78 patients with AAV. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were collected as indices reflecting cross-sectional comprehensive inflammation, whereas the Birmingham vasculitis activity score (bVAS), and the five-factor score (FFS) were reviewed as AAV-specific indices. All-cause mortality was considered to be a poor outcome during follow-up. cMDA was measured from stored sera. Results: The median age of the 78 patients (32 men and 46 women) was 63.0 years. The median BVAS, FFS, ESR, and CRP were 5.0, 0, 24.5 mm/h, and 3.4 mg/L, respectively. Six patients died during the median follow-up duration based on all-cause mortality at 26.7 months. At diagnosis, cMDA was significantly correlated with cross-sectional ESR but not with BVAS or FFS. Compared to patients with cMDA < 221.7 ng/mL, those with cMDA ≥ 221.7 ng/mL at diagnosis exhibited an increased relative risk (RR 12.4) for all-cause mortality and further showed a decreased cumulative patient survival rate. Cox analyses revealed that cMDA ≥ 221.7 ng/mL (hazard ratio 24.076, p = 0.007) exhibited an independent association with all-cause mortality during follow-up in patients with AAV. Conclusions: cMDA at diagnosis may be a potential biomarker for predicting all-cause mortality during follow-up by reflecting comprehensive inflammation at diagnosis in patients with AAV.

Prescription patterns of statins in cirrhotic patients: a survey among primary care physicians and cardiologists

Background

Statin therapy is widely utilized for preventing atherosclerotic cardiovascular disease, both as a primary and secondary measure. Despite the American Association for the Study of Liver Diseases' endorsement of statin use in cirrhotic patients, practitioners exhibit hesitancy, primarily due to concerns regarding hepatotoxicity. This study aimed to evaluate statin prescription patterns in cirrhotic patients by primary care physicians (PCPs) and cardiologists through a survey.

Methods

A voluntary survey via Survey Monkey with nine objective-type questions was sent to 220 PCPs and 75 cardiologists within Allegheny Health Network. Survey results were collected, and a chi square test was used to compare the two groups. A P value ≤ 0.05 was considered statistically significant.

Results

A total of 64 PCPs (29.1%) and 15 cardiologists (20%) completed the survey. Overall, 12.6% did not prescribe statins for primary prevention of atherosclerotic cardiovascular disease in compensated cirrhotic patients. While all cardiologists prescribed statins for secondary prevention, over 50% preferred lower-intensity options. Conversely, 14.1% of PCPs avoided statin prescriptions for secondary prevention. Cardiologists were significantly more inclined to prescribe statins, especially for cirrhosis due to metabolic dysfunction-associated steatotic liver disease compared to PCPs (73.3% vs 45.3%, P = 0.05).

Conclusions

Despite increasing evidence favoring use of statins in cirrhosis for improving portal hemodynamics and decreasing ascites, hepatic encephalopathy, the incidence of hepatocellular carcinoma, and mortality, there is still hesitation on the part of prescribers for the fear of worsening liver disease. Wider dissemination of current guidelines and education practices may help to bridge this gap.

Characterization of an Algorithm for Autonomous, Closed-Loop Neuromodulation During Motor Rehabilitation

BACKGROUND

Recent evidence demonstrates that manually triggered vagus nerve stimulation (VNS) combined with rehabilitation leads to increased recovery of upper limb motor function after stroke. This approach is premised on studies demonstrating that the timing of stimulation relative to movements is a key determinant in the effectiveness of this approach.

OBJECTIVE

The overall goal of the study was to identify an algorithm that could be used to automatically trigger VNS on the best movements during rehabilitative exercises while maintaining a desired interval between stimulations to reduce the burden of manual stimulation triggering.

METHODS

To develop the algorithm, we analyzed movement data collected from patients with a history of neurological injury. We applied 3 different algorithms to the signal, analyzed their triggering choices, and then validated the best algorithm by comparing triggering choices to those selected by a therapist delivering VNS therapy.

RESULTS

The dynamic algorithm triggered above the 95th percentile of maximum movement at a rate of 5.09 (interquartile range [IQR] = 0.74) triggers per minute. The periodic algorithm produces stimulation at set intervals but low movement selectivity (34.05%, IQR = 7.47), while the static threshold algorithm produces long interstimulus intervals (27.16 ± 2.01 seconds) with selectivity of 64.49% (IQR = 25.38). On average, the dynamic algorithm selects movements that are 54 ± 3% larger than therapist-selected movements.

CONCLUSIONS

This study shows that a dynamic algorithm is an effective strategy to trigger VNS during the best movements at a reliable triggering rate.

Intake of Snacks and Sweets in a National Study of Built and Social Environments: the REasons for Geographic And Racial Differences in Stroke Study

BACKGROUND

Few national studies across the United States' rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults.

OBJECTIVES

This study examines associations of urbanicity/rurality-tailored measures of food store availability and neighborhood socioeconomic status (NSES) with the intake of snacks and sweets in a national sample of middle and older age adults.

METHODS

This cross-sectional study used food frequency questionnaire data collected in the REasons for Geographic And Racial Differences in Stroke study (N = 21,204). What We Eat in America food group categorizations guided outcome classification into 1 main category (total snacks and sweets) and 4 subcategories (savory snacks and crackers; sweet bakery products; candy and desserts; nutrition bars and low-fat snacks and sweets). NSES and food store availability were determined using geographic information systems. Food store availability was characterized as geographic access to primary food stores (e.g., supermarkets, supercenters, and select food retailers) in urbanicity/rurality-tailored neighborhood-based buffers. Multiple linear regression was used to predict each outcome.

RESULTS

Living in neighborhoods with a high density of primary food stores was associated with 8.6%, 9.5%, and 5.8% lower intake of total snacks and sweets, sweet bakery products, and candy and desserts, respectively. Living in the highest NSES quartile was associated with 11.3%, 5.8%, and 18.9% lower intake of total snacks and sweets, savory snacks and crackers, and sweet bakery products, respectively. Depending on primary food store availability, higher household income was associated with significantly greater intake of nutrition bars and low-fat snacks and sweets. Living in a United States Department of Agriculture-defined food desert was not associated with intake.

CONCLUSIONS

In a geographically diverse sample of middle and older age United States adults, living in neighborhoods with no primary food stores or neighborhoods of low-SES was associated with higher intake of total snacks and sweets and subgroups of snacks and sweets.

Validation of Pelvis and Trunk Range of Motion as Assessed Using Inertial Measurement Units

Trunk and pelvis range of motion (ROM) is essential to perform activities of daily living. The ROM may become limited with aging or with neuromusculoskeletal disorders. Inertial measurement units (IMU) with out-of-the box software solutions are increasingly being used to assess motion. We hypothesize that the accuracy (validity) and reliability (consistency) of the trunk and pelvis ROM during steady-state gait in normal individuals as measured using the Opal APDM 6 sensor IMU system and calculated using Mobility Lab version 4 software will be comparable to a gold-standard optoelectric motion capture system. Thirteen healthy young adults participated in the study. Trunk ROM, measured using the IMU was within 5-7 degrees of the motion capture system for all three planes and within 10 degrees for pelvis ROM. We also used a triad of markers mounted on the sternum and sacrum IMU for a head-to-head comparison of trunk and pelvis ROM. The IMU measurements were within 5-10 degrees of the triad. A greater variability of ROM measurements was seen for the pelvis in the transverse plane. IMUs and their custom software provide a valid and reliable measurement for trunk and pelvis ROM in normal individuals, and important considerations for future applications are discussed.

Clinical Outcomes of Aspirin and Clopidogrel among Patients with Chronic Obstructive Lung Disease: Insights from a Meta-Analysis

(1) Background: Aspirin and clopidogrel have been found helpful in improving clinical outcomes among patients with chronic obstructive lung disease (COPD). However, the evidence on the efficacy of aspirin and/or clopidogrel on clinical outcomes has not been synthesized and summarized in the prior reviews. Hence, we undertook a meta-analysis of the research studies examining the effect of aspirin and/or clopidogrel on varying clinical outcomes among COPD patients; (2) Methods: Using key search terms, we searched databases, including MEDLINE, CINAHL, Google Scholar, and EMBASE to find observational studies and RCTs. Our search was limited to research written in English. We used a random effect model to calculate the 95% confidence intervals and pooled hazard ratio; (3) Results: We included 12 eligible research studies (33,8008 patients) in the current meta-analysis. Among COPD patients, the hazard of all-cause mortality among users of aspirin or clopidogrel was 17% lower (HR: 0.83; 95% CIs (0.70, 0.97; I2 = 73%, X2: 33.34) compared to non-users of anticoagulants (aspirin or clopidogrel). The hazard of dyspnea among users of aspirin or clopidogrel was 3% lower (HR: 0.97; 95% CIs (0.27, 3.49; I2 = 93%, X2: 42.15) compared to non-users of anticoagulants (aspirin or clopidogrel). There was no statistically significant effect of aspirin on other clinical outcomes such as myocardial infarction (HR: 2.04; 95% CIs (0.02, 257.33) and major bleeding (HR: 1.93; 95% CIs (0.07, 1002.33). The funnel plot and Egger's regression test did not show any evidence of publication bias; (4) Conclusions: Overall, we found a positive and beneficial effect of aspirin and/or clopidogrel in reducing all-cause mortality among COPD patients. However, there is uncertainty of evidence for other clinical outcomes such as exacerbation of dyspnea, myocardial infarction, and major bleeding. A limited number of studies examining other clinical outcomes warrant conducting more robust epidemiological studies to assess the efficacy and safety of aspirin and clopidogrel on other clinical outcomes among COPD patients.

Association between illegal drug use and cigarette smoking among Ethiopian students: A systematic review and meta-analysis

INTRODUCTION

Cigarette smoking is a persistent public health problem as it is a risk factor for many diseases. Previous studies on the role of illegal drug use in cigarette smoking have yielded disparate and inconclusive results, hindering the development of effective intervention strategies to address this issue. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of cigarette smoking and its associated factors, with a specific focus on the influence of illegal drug use among students in Ethiopia.

METHODS

We conducted a comprehensive search of international databases, including PubMed, Cochrane Library, Science Direct, CINAHL, African Journals Online, HINARI, Global Health, and Google and Google Scholar. Grey literature was also identified from various university digital libraries. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. Due to the high heterogeneity among the included studies (I2 = 98.6%; p-value <0.001), we employed a random-effects model with a 95% confidence interval (CI) to estimate the pooled effect using STATA 14 software. The publication bias was assessed using a statistical Egger regression test.

RESULTS

A total of 22 studies involving 18,144 students met the eligibility criteria for this systematic review and meta-analysis. The pooled prevalence of lifetime and current cigarette smoking among students in Ethiopia was 13.8% (95% CI: 9.90-17.82) and 9.61% (95% CI: 7.19-12.03), respectively. Students who used illegal drugs were twenty-three times more likely to smoke cigarettes compared to their counterparts (OR = 23.57, 95% CI: 10.87-51.1). Living in urban settings (OR = 2.9; 95% CI: 1.15-7.28) and the habit of alcohol consumption (OR = 4.79; 95% CI: 1.57-14.64) were also identified as factors associated with cigarette smoking.

CONCLUSIONS

We found that more than one in eight students in Ethiopia have engaged in lifetime cigarette smoking. Notably, students who used illegal drugs exhibited a significantly higher likelihood of cigarette smoking. In light of these findings, it is imperative to implement comprehensive public health interventions that target illegal drug use, cigarette smoking, and alcohol consumption, with a particular emphasis on urban residents.

Antidepressant discontinuation patterns and characteristics across sociodemographic groups in the United States

BACKGROUND

While antidepressants are frequently used, less is known about contemporary discontinuation patterns, especially across different sociodemographic populations.

METHODS

Patients 16-84 years initiating antidepressants between 2016 and 2019 within a large US health insurer were identified. The association between patient characteristics and time until antidepressant discontinuation was evaluated using adjusted Cox proportional hazard regression.

RESULTS

Across 1,365,576 patients, mean time to discontinuation was 168.1 days (SD: 223.6). Men were more likely to discontinue than women (HR: 0.94, 95%CI: 0.94-0.94). Younger patients (16-24 years) were more likely to discontinue than older patients. Patients who were non-White (Asian HR: 1.33, 95%CI: 1.31-1.34; Black HR: 1.27, 95%CI: 1.27-1.28; Hispanic HR: 1.34, 95%:CI 1.34-1.35), with evidence of a substance use disorder (HR: 1.31, 95%CI: 1.27-1.35), or taking tricyclic antidepressants (HR:1.26, 95%CI: 1.25-1.27) were more likely to discontinue.

LIMITATIONS

Information on reasons for discontinuation was not available, and wide standard deviations for the primary outcome were reported. The results may not be generalized to non-commercially insured beneficiaries.

CONCLUSIONS

Discontinuation is common within the first 6 months of treatment but varies across populations, highlighting patients who may benefit from potential intervention.

The role and impact of voice physiotherapy: A qualitative study of service user perspectives

BACKGROUND

Physiotherapy has the potential to benefit people with voice and throat problems in conjunction with existing services.

PURPOSE

This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services.

METHODS

An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practice. Transcripts were analyzed with a general inductive approach suitable for qualitative evaluation data. Data were analyzed from six interviews and four main themes emerged, with each theme further characterized by categories.

RESULTS

Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; facilitates individualized specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; Valuable service. Each theme is further illustrated by categories.

CONCLUSION

This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem and facilitating specific management. There is great potential for physiotherapy to benefit voice users. Future research should further evaluate the potential to include physiotherapy in the voice care team and consider how best to capture the broad impacts illustrated.

Nuclear factor κB overactivation in the intervertebral disc leads to macrophage recruitment and severe disc degeneration

Persistent inflammation has been associated with severe disc degeneration (DD). This study investigated the effect of prolonged nuclear factor κB (NF-κB) activation in DD. Using an inducible mouse model, we genetically targeted cells expressing aggrecan, a primary component of the disc extra cellular matrix, for activation of the canonical NF-κB pathway. Prolonged NF-κB activation led to severe structural degeneration accompanied by increases in gene expression of inflammatory molecules (Il1b, Cox2, Il6, and Nos2), chemokines (Mcp1 and Mif), and catabolic enzymes (Mmp3, Mmp9, and Adamts4). Increased recruitment of proinflammatory (F4/80+,CD38+) and inflammatory resolving (F4/80+,CD206+) macrophages was observed within caudal discs. We found that the secretome of inflamed caudal disc cells increased macrophage migration and inflammatory activation. Lumbar discs did not exhibit phenotypic changes, suggestive of regional spinal differences in response to inflammatory genetic overactivation. Results suggest prolonged NF-κB activation can induce severe DD through increases in inflammatory cytokines, chemotactic proteins, catabolic enzymes, and the recruitment and activation of macrophage cell populations.

The association between hepatitis C virus infection status and blood pressure in adults in the United States: NHANES 1999-2012

Background

The Hepatitis C virus (HCV) infection is strongly associated with cardiovascular disease risk factors, but the relationship with blood pressure (BP) remains unclear.

Objectives

To assess the association between HCV infection status and BP in US adults.

Methods

Data for the study were obtained from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2012. The association of HCV infection status (including HCV infection, current HCV infection, and past HCV infection) with hypertension, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were explored using logistic or linear regression analyses respectively.

Results

A total of 25,850 participants (age≥18 years) were enrolled in the current study, including 14,162 participants with hypertension. After adjusting for all covariates, HCV infection/current HCV infection was not associated with hypertension and SBP compared to participants with non-HCV infection (OR: 1.34,95% CI 0.96-1.87/1.31 95% CI 0.91,1.91, β: -0.92, 95% CI -2.7-0.86/-0.35 95% CI -2.51,1.81, respectively). HCV infection/current HCV infection was only associated with elevated DBP (β: 4.1,95% CI 2.57-5.63/4.24,95% CI 2.27-6.21). However, there was no correlation with past HCV infection in participants with hypertension, SBP, and DBP compared to those with non-HCV infection (OR: 1.23,95% CI 0.59-2.54; β: -3.79, 95% CI -7.67-0.08 and 2.28 95% CI -0.36-4.92, respectively).

Conclusion

In a representative sample of US adults, it was found that both HCV infection and current HCV infection were independently linked to higher DBP. However, there was no association between past HCV infection and DBP.

Safety of cervical transforaminal epidural steroid injections

Background

In 2014 the FDA issued a drug safety warning that steroids in the epidural space may result in rare but serious neurological adverse events. The FDA identified 131 cases of neurological adverse events and most complications were related to cervical transforaminal epidural injections (TFESIs). These complications occurred before the standard use of non-particulate steroids. Many still consider cervical TFSEIs to be unsafe.

Objectives

The objective of this study was to evaluate the safety of cervical TFESIs with non-particulate steroids.

Methods

A review was done of all cervical TFESIs from 2004 to 2021 at an academic institution when non-particulate steroids became more commonly used by reviewing CPT code 64479 linked to the performing physician. All treating physicians and department directors were queried about catastrophic complications (stroke, spinal cord injury, death or other). A secondary analysis was done on 200 consecutive cervical TFESIs looking at immediate and delayed side-effects documented by the nurse in recovery, day-after phone calls and clinic follow-up notes.

Results

From 2004 to 2021 the CPT code 64479 was used 6967 times, with 6241 cervical TFESIs and 726 thoracic TFESIs. No catastrophic complications occurred. In the subset analysis of 200 consecutive cervical TFESIs, 7 patients (3.5 %, 95 % CI 1.0-6.0) had a transient increase in pain, 18 (9 %, 95 % CI 5.0-13.0) had no change in pain and 171 (85.5 %, 95 % CI 80.6-90.4) had a decrease in pain. The average pain score among all participants dropped 3.7 (95 % 3.0-4.4) points. A 2-point drop was seen in 75.5 % (95 % CI 69.5-81.5) and a 3-point drop was seen in 62.5 % (95 % CI 59.1-65.9). Five of the seven patients with transient increased pain had an increase of ≥ 3 points on numerical rating scale. There was one of each of the following reported: insomnia, glucose >500, transient thumb numbness with pain, and hypertension. Two cases of headaches were reported.

Conclusion

This study supports the safety of cervical TFESIs with non-particulate steroids as recommended by consensus opinions from medical societies.

Medical Nutrition Education for Health, Not Harm: BMI, Weight Stigma, Eating Disorders, and Social Determinants of Health

Effective nutrition training is fundamental to medical education. Current training is inadequate and can cause harm to students and patients alike; it leaves physicians unprepared to counsel on nutrition, places undue focus on weight and body mass index (BMI), can exacerbate anti-obesity bias, and increase risk for development of eating disorders, while neglecting social determinants of health and communication skills. Physicians and educators hold positions of influence in society; what we say and how we say it matters. We propose actionable approaches to improve nutrition education to minimize harm and pursue evidence-based, effective, and equitable healthcare.

The common marmoset as a translational model of age-related osteoarthritis

Age-related osteoarthritis (OA) is a degenerative joint disease characterized by pathological changes in nearly every intra- and peri-articular tissue that contributes to disability in older adults. Studying the etiology of age-related OA in humans is difficult due to an unpredictable onset and insidious nature. A barrier in developing OA modifying therapies is the lack of translational models that replicate human joint anatomy and age-related OA progression. The purpose of this study was to determine whether the common marmoset is a faithful model of human age-related knee OA. Semi-quantitative microCT scoring revealed greater radiographic OA in geriatric versus adult marmosets, and the age-related increase in OA prevalence was similar between marmosets and humans. Quantitative assessments indicate greater medial tibial cortical and trabecular bone thickness and heterogeneity in geriatric versus adult marmosets which is consistent with an age-related increase in focal subchondral bone sclerosis. Additionally, marmosets displayed an age-associated increase in synovitis and calcification of the meniscus and patella. Histological OA pathology in the medial tibial plateau was greater in geriatric versus adult marmosets driven by articular cartilage damage, proteoglycan loss, and altered chondrocyte cellularity. The age-associated increase in medial tibial cartilage OA pathology and meniscal calcification was greater in female versus male geriatric marmosets. Overall, marmosets largely replicate human OA as evident by similar 1) cartilage and skeletal morphology, 2) age-related progression in OA pathology, and 3) sex differences in OA pathology with increasing age. Collectively, these data suggest that the common marmoset is a highly translatable model of the naturally occurring, age-related OA seen in humans.

Lycopene potentiates wound healing in streptozotocin-induced diabetic rats

Background

Diabetes is a growing metabolic disease that is characterized by high blood sugar levels with life-threatening results. Diabetic wounds are a major problem because they do not resolve in few days. Major problems affecting wound healing are infection, age, stress, etc. at the wound site, and other associated disease conditions. Lycopene is a red pigment obtained from various fruits such as tomatoes, watermelon, and guava. It is a powerful antioxidant that scavenges reactive oxygen species and potential as nutraceuticals. It has reported antidiabetic, antioxidant, anti-obesity, anti-inflammatory, antihyperglycemic, and antiaging activities based on the literature.

Objective

The objective of the current study is to find the wound-healing potential of lycopene emulgel (LE) and report the properties of the compound.

Methods

Wound healing activity was assessed in Streptozotocin induced diabetic rats and control rats. Streptozotocin injection (55 mg/kg) was used to induce marked hyperglycaemia, compared with controls. The formulation was applied topically and was evaluated for efficacy.

Results

Treatment of rats with lycopene emulgel (LE) topical application exhibited a significant reduction of wound closure of 95.3 and 88.9% and epithelisation within 21 days.

Conclusion

The formulation was found to be novel, safe, and effective in the functional recovery of wounds.

Pharmacokinetics of a Fixed-Dose Combination Product of Amlodipine, Losartan, Ezetimibe, and Rosuvastatin and Its Comparison with Co-administration of Four Individual Components in Healthy Participants

BACKGROUND AND OBJECTIVE

This study aimed to assess and compare the pharmacokinetics, safety, and tolerability of a fixed-dose combination product (FDCP) comprising four different drugs (two antihypertensive drugs, amlodipine and losartan, and two lipid-lowering agents, ezetimibe and rosuvastatin) with their separate tablets.

METHODS

A total of 60 participants were enrolled in this open-label, randomized, single-dose crossover study. Each participant received a single dose of FDCP and individual tablets during each period, with a 14-day washout period between the periods. The pharmacokinetic parameters of amlodipine, losartan, EXP3174 (an active metabolite of losartan), rosuvastatin, free ezetimibe, and total ezetimibe were evaluated and compared.

RESULTS

The pharmacokinetic profiles of amlodipine, losartan, rosuvastatin, and ezetimibe after administration of the individual products were similar to those of FDCP. The geometric mean ratios and 90% confidence intervals for maximum concentration (Cmax) and area under the curve (AUC) of FDCP to individual tablets were within 0.8-1.25 for all six analytes. No clinically relevant changes were observed in the vital signs or physical, biochemical, hematological, electrocardiographic, or urinalysis findings during the study, and no serious adverse events were reported.

CONCLUSION

This study demonstrated that a newly developed FDCP containing amlodipine, losartan, ezetimibe, and rosuvastatin exhibited pharmacokinetic equivalence with the individual products and met the regulatory criteria. Both formulations were well tolerated.

CLINICAL TRIAL REGISTRATION

This trial (NCT04322266) was retrospectively registered on 9 September 2019.

Advanced subject-specific neck musculoskeletal modeling unveils sex differences in muscle moment arm and cervical spine loading

Neck pain and injuries are growing healthcare burdens with women having a higher incidence rate and poorer treatment outcomes than males. A better understanding of sex differences in neck biomechanics, foundational for more targeted, effective prevention or treatment strategies, calls for more advanced subject-specific musculoskeletal modeling. Current neck musculoskeletal models are based on generic anatomy, lack subject specificity beyond anthropometric scaling, and are unable to accurately reproduce neck strengths exhibited in vivo without arbitrary muscle force scaling factors or residual torque actuators. In this work, subject-specific neck musculoskeletal models of 23 individuals (11 male, 12 female) were constructed by integrating multi-modality imaging and biomechanical measurements. Each model simulated maximal voluntary neck static exertions in three postures: neck flexion in a neutral posture, flexion in a 40° extended posture, and extension in a 40° flexed posture. Quantitative model validation showed close agreement between model-predicted muscle activation and EMG measurement. The models unveiled that (1) males have greater moment arms in one flexor muscle group and five extensor muscle groups, (2) females exhibited higher cervical spinal compression per unit exertion force in the flexed posture, and (3) the variability of compression force was much greater in females in all three exertions but most notably in the extension with a flexed "dropped head" position. These insights illuminated a plausible pathway from sex differences in neck biomechanics to sex disparities in the risk and prevalence of neck pain.

Frontoparietal beta event characteristics are associated with early life stress and psychiatric symptoms in adults

Recent work has found that the presence of transient, oscillatory burst-like events, particularly within the beta band (15-29 Hz), is more closely tied to disease state and behavior across species than traditional electroencephalography (EEG) power metrics. This study sought to examine whether features of beta events over frontoparietal electrodes were associated with early life stress (ELS) and the related clinical presentation. Eighteen adults with documented ELS (n = 18; ELS + ) and eighteen adults without documented ELS (n = 18; ELS-) completed eyes-closed resting state EEG as part of their participation in a larger childhood stress study. The rate, power, duration, and frequency span of transient oscillatory events were calculated within the beta band at five frontoparietal electrodes. ELS variables were positively associated with beta event rate at Fp2 and beta event duration at Pz, in that greater ELS was associated with higher resting rates and longer durations. These beta event characteristics were used to successfully distinguish between ELS + and ELS- groups. In an independent clinical dataset (n = 25), beta event power at Pz was positively correlated with ELS. Beta events deserve ongoing investigation as a potential disease marker of ELS and subsequent psychiatric treatment outcomes.

Care dependency in older stroke patients with comorbidities: a latent profile analysis

Objectives

To explore latent profiles of care dependency in older stroke patients with comorbidities and to analyze the factors influencing different latent profiles.

Methods

A total of 312 older ischemic stroke patients with comorbidities were included in the analysis. Latent Profile Analysis (LPA) was used to classify the participants into potential subgroups with different types of care dependency. The influencing factors of the classification of care dependency subgroups were determined using multivariate Logistic regression analysis.

Results

The care dependency score of older ischemic stroke patients with comorbidities was (51.35 ± 13.19), and the patients could be classified into 3 profiles, namely Universal dependency (24.0%), Moderate activity-social-learning dependency (28.0%), and Mild activity-social-learning dependency (48.0%); caregiver, BI at admission, and functional impairments were independent factors influencing care dependency (P < 0.05).

Conclusion

There are three latent profiles of care dependency in older ischemic stroke patients with comorbidities. According to the characteristics of various populations, medical staff are able to implement specific interventions to lower the level of dependency and further improve the quality of life of patients.

Prenatal SARS-CoV-2 infection results in neurodevelopmental and behavioral outcomes in mice

Prenatal exposure to viral pathogens has been known to cause the development of neuropsychiatric disorders in adulthood. Furthermore, COVID-19 has been associated with a variety of neurological manifestations, raising the question of whether in utero SARS-CoV-2 exposure can affect neurodevelopment, resulting in long-lasting behavioral and cognitive deficits. Using a human ACE2-knock-in mouse model, we have previously shown that prenatal exposure to SARS-CoV-2 at later stages of development leads to fetal brain infection and gliosis in the hippocampus and cortex. In this study, we aimed to determine whether infection of the fetal brain results in long-term neuroanatomical alterations of the cortex and hippocampus or in any cognitive deficits in adulthood. Here, we show that infected mice developed slower and weighed less in adulthood. We also found altered hippocampal and amygdala volume and aberrant newborn neuron morphology in the hippocampus of adult mice infected in utero. Furthermore, we observed sex-dependent alterations in anxiety-like behavior and locomotion, as well as hippocampal-dependent spatial memory. Taken together, our study reveals long-lasting neurological and cognitive changes as a result of prenatal SARS-CoV-2 infection, identifying a window for early intervention and highlighting the importance of immunization and antiviral intervention in pregnant women.

The effect of suboccipital muscle dysfunction on the biomechanics of the upper cervical spine: a study based on finite element analysis

OBJECTIVE

Muscle dysfunction caused by repetitive work or strain in the neck region can interfere muscle responses. Muscle dysfunction can be an important factor in causing cervical spondylosis. However, there has been no research on how the biomechanical properties of the upper cervical spine change when the suboccipital muscle group experiences dysfunction. The objective of this study was to investigate the biomechanical evidence for cervical spondylosis by utilizing the finite element (FE) approach, thus and to provide guidance for clinicians performing acupoint therapy.

METHODS

By varying the elastic modulus of the suboccipital muscle, the four FE models of C0-C3 motion segments were reconstructed under the conditions of normal muscle function and muscle dysfunction. For the two normal condition FE models, the elastic modulus for suboccipital muscles on both sides of the C0-C3 motion segments was equal and within the normal range In one muscle dysfunction FE model, the elastic modulus on both sides was equal and greater than 37 kPa, which represented muscle hypertonia; in the other, the elastic modulus of the left and right suboccipital muscles was different, indicating muscle imbalance. The biomechanical behavior of the lateral atlantoaxial joint (LAAJ), atlanto-odontoid joint (ADJ), and intervertebral disc (IVD) was analyzed by simulations, which were carried out under the six loadings of flexion, extension, left and right lateral bending, left and right axial rotation.

RESULTS

Under flexion, the maximum stress in LAAJ with muscle imbalance was higher than that with normal muscle and hypertonia, while the maximum stress in IVD in the hypertonic model was higher than that in the normal and imbalance models. The maximum stress in ADJ was the largest under extension among all loadings for all models. Muscle imbalance and hypertonia did not cause overstress and stress distribution abnormalities in ADJ.

CONCLUSION

Muscle dysfunction increases the stress in LAAJ and in IVD, but it does not affect ADJ.

Disentangling associations between pubertal development, healthy activity behaviors, and sex in adolescent social networks

With the onset of puberty, youth begin to choose their social environments and develop health-promoting habits, making it a vital period to study social and biological factors contextually. An important question is how pubertal development and behaviors such as physical activity and sleep may be differentially linked with youths' friendships. Cross-sectional statistical network models that account for interpersonal dependence were used to estimate associations between three measures of pubertal development and youth friendships at two large US schools drawn from the National Longitudinal Study of Adolescent to Adult Health. Whole-network models suggest that friendships are more likely between youth with similar levels of pubertal development, physical activity, and sleep. Sex-stratified models suggest that girls' friendships are more likely given a similar age at menarche. Attention to similar pubertal timing within friendship groups may offer inclusive opportunities for tailored developmental puberty education in ways that reduce stigma and improve health behaviors.

Dried Plasma for Major Trauma: Past, Present, and Future

Uncontrollable bleeding is recognized as the leading cause of preventable death among trauma patients. Early transfusion of blood products, especially plasma replacing crystalloid and colloid solutions, has been shown to increase survival of severely injured patients. However, the requirements for cold storage and thawing processes prior to transfusion present significant logistical challenges in prehospital and remote areas, resulting in a considerable delay in receiving thawed or liquid plasma, even in hospitals. In contrast, freeze- or spray-dried plasma, which can be massively produced, stockpiled, and stored at room temperature, is easily carried and can be reconstituted for transfusion in minutes, provides a promising alternative. Drawn from history, this paper provides a review of different forms of dried plasma with a focus on in vitro characterization of hemostatic properties, to assess the effects of the drying process, storage conditions in dry form and after reconstitution, their distinct safety and/or efficacy profiles currently in different phases of development, and to discuss the current expectations of these products in the context of recent preclinical and clinical trials. Future research directions are presented as well.

Clinical Practice Guideline: Age-Related Hearing Loss Executive Summary

OBJECTIVE

Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition.

PURPOSE

The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with an explanation of the support in the literature, the evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the Guideline Development Group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.

ACTION STATEMENTS

The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life. (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related quality of life at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.

Postoperative Bisphosphonates Use is Associated with Reduced Adverse Outcomes After Primary Total Joint Arthroplasty of Hip and Knee: A Nationwide Population-Based Cohort Study

Bisphosphonates have been associated with a decreased risk of revision surgery after total joint arthroplasty of the hip or knee (TJA) because of their effects on decreased periprosthetic bone loss and prosthetic migration. However, the results in the early literature are inconsistent, and the influence of bisphosphonates on associated complications and subsequent TJA remains unknown. This study investigated the association between the use of bisphosphonates and the risk of adverse outcomes after primary TJA. This matched cohort study utilized the National Health Insurance Research Database in Taiwan to identify patients who underwent primary TJA over a 15-year period (January 2000-December 2015 inclusive). Study participants were further categorized into two groups, bisphosphonate users and nonusers, using propensity score matching. The Kaplan-Meier curve analysis and adjusted hazard ratios (aHRs) of revision surgery, adverse outcomes of primary surgery and subsequent TJA were calculated using Cox regression analysis. This study analyzed data from 6485 patients who underwent total hip arthroplasty (THA) and 20,920 patients who underwent total knee arthroplasty (TKA). The risk of revision hip and knee arthroplasty was significantly lower in the bisphosphonate users than in the nonusers (aHR, 0.54 and 0.53, respectively). Furthermore, the risk of a subsequent total joint arthroplasty, adverse events and all-cause mortality were also significantly reduced in the bisphosphonate users. This study, involving a large cohort of patients who underwent primary arthroplasties, revealed that bisphosphonate treatment may potentially reduce the risk of revision surgery and associated adverse outcomes. Furthermore, the use of bisphosphonates after TJA is also associated with a reduced need for subsequent arthroplasty.Research Registration Unique Identifying Number (UIN): ClinicalTrials.gov Identifier-NCT05623540 ( https://clinicaltrials.gov/show/NCT05623540 ).

Clinical Practice Guideline: Age-Related Hearing Loss

OBJECTIVE

Age-related hearing loss (ARHL) is a prevalent but often underdiagnosed and undertreated condition among individuals aged 50 and above. It is associated with various sociodemographic factors and health risks including dementia, depression, cardiovascular disease, and falls. While the causes of ARHL and its downstream effects are well defined, there is a lack of priority placed by clinicians as well as guidance regarding the identification, education, and management of this condition.

PURPOSE

The purpose of this clinical practice guideline is to identify quality improvement opportunities and provide clinicians trustworthy, evidence-based recommendations regarding the identification and management of ARHL. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. The target patients for the guideline are any individuals aged 50 years and older. The target audience is all clinicians in all care settings. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of ARHL. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.

ACTION STATEMENTS

The GDG made strong recommendations for the following key action statements (KASs): (KAS 4) If screening suggests hearing loss, clinicians should obtain or refer to a clinician who can obtain an audiogram. (KAS 8) Clinicians should offer, or refer to a clinician who can offer, appropriately fit amplification to patients with ARHL. (KAS 9) Clinicians should refer patients for an evaluation of cochlear implantation candidacy when patients have appropriately fit amplification and persistent hearing difficulty with poor speech understanding. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should screen patients aged 50 years and older for hearing loss at the time of a health care encounter. (KAS 2) If screening suggests hearing loss, clinicians should examine the ear canal and tympanic membrane with otoscopy or refer to a clinician who can examine the ears for cerumen impaction, infection, or other abnormalities. (KAS 3) If screening suggests hearing loss, clinicians should identify sociodemographic factors and patient preferences that influence access to and utilization of hearing health care. (KAS 5) Clinicians should evaluate and treat or refer to a clinician who can evaluate and treat patients with significant asymmetric hearing loss, conductive or mixed hearing loss, or poor word recognition on diagnostic testing. (KAS 6) Clinicians should educate and counsel patients with hearing loss and their family/care partner(s) about the impact of hearing loss on their communication, safety, function, cognition, and quality of life (QOL). (KAS 7) Clinicians should counsel patients with hearing loss on communication strategies and assistive listening devices. (KAS 10) For patients with hearing loss, clinicians should assess if communication goals have been met and if there has been improvement in hearing-related QOL at a subsequent health care encounter or within 1 year. The GDG offered the following KAS as an option: (KAS 11) Clinicians should assess hearing at least every 3 years in patients with known hearing loss or with reported concern for changes in hearing.