The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies

Investigating the role of top-down regulation and bottom-up cues in eating styles transitions: a one-year cohort study with young adults

Young adults often experience deterioration in eating habits during transition periods. However, longitudinal evidence on the changes of eating styles and associated determinants remains limited. This study aimed to explore the eating style transitions among young adults in their graduate transitions and investigate the influences of top-down regulatory factors and bottom-up environmental cues on their eating style transitions. This is a two-wave cohort study involving 594 Hong Kong young adults completing the baseline assessment during their post-secondary graduation year, of whom, 424 completed the one-year follow-up survey. Eating behaviours were measured at both points. Executive function (EF), coping style, exposure to digital food environments, responsiveness to food cues, perceived stress and demographics were also measured. Latent profile analysis was used to explore main eating styles among participants while multinomial logistic regression models were used to assess determinants of eating style transitions. In follow-up assessment, 5.9 % of participants were consistently approaching eaters (APE) across two time points, while 28.8 % have transitioned from moderate eaters (MOE) or APE to mixed eaters (MIE). The multinominal logistic regression model revealed that although EF and coping style were no longer significantly associated with participants' eating style transitions outcomes, greater exposure to digital food environments (OR = 2.60, p = 0.028) and higher responsiveness to food cues (OR = 5.86, p = 0.005) were associated with Persistent APE, while higher responsiveness to food cues (OR = 2.36, p = 0.009) and higher perceived stress (OR = 1.05, p = 0.046) were associated with Converted MIE. Bottom-up cues may dominate eating style transitions compared to top-down regulations. Future interventions should leverage environmental cues, thereby targeting the automatic decision-making process and supporting healthy eating habits during stressful life stages.

Community Specialist Teams for Older Persons (CST-OP) at risk of, or living with frailty in Ireland: a prospective cohort study of a new model of integrated care for community dwelling older adults

BACKGROUND

This study explored the clinical and process outcomes of older adults at risk of or living with frailty who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the community.

METHODS

This prospective cohort study recruited older adults aged ≥ 75 who were screened for frailty and referred to one of three CST-OP hubs in the Mid-West of Ireland by their GP. Follow-up assessments were conducted via telephone by an independent assessor at 30- and 180-days. The primary outcome was functional status. Secondary outcomes included primary healthcare use, secondary healthcare use, nursing home admission, health-related quality of life (HRQoL), patient satisfaction and mortality.

RESULTS

A total of 303 participants (mean age = 83.2 years) were recruited. Incidence of 30- and 180-day functional decline was 26.4% and 33.7% respectively. The majority of older adults who availed of community-based CGA maintained functional independence up to 6-months post index visit. At 30-days, the mortality rate was 1.0%, Emergency Department (ED) presentation 6.9%, hospitalisation 6.6% and nursing home admission 4.0%. HRQoL significantly improved at 30- and 180-days. There was a significant improvement in HRQoL, F(2,542) = 13.8, p < 0.001, η2 = 0.5. The presence of frailty was a significant predictor of adverse outcomes.

CONCLUSION

Community-based CGA results in favorable health outcomes including HRQoL among community-dwelling older adults. Community-based CGA may also mitigate against potentially avoidable ED presentations and hospitalisations. Use of the Clinical Frailty Scale is recommended to predict the risk of functional decline, increased rates of mortality, NH admission, hospitalisation or ED presentation at 30- and 180-days among community-dwelling older adults.

TRIAL REGISTRATION

The study protocol was prospectively registered on Clinicaltrials.gov (NCT05527223). Registered January 09, 2022. https://clinicaltrials.gov ..

Long-term non-conditional and conditional metastasis of uveal melanoma by tumor size category in 8034 patients

PURPOSE

To estimate metastasis of patients with uveal melanoma (UM) based on tumor size categories classified by ultrasonographic thickness as small (0.0-3.0 mm), medium (3.1-8.0 mm), or large (≥8.1 mm) using both non-conditional and conditional analyses.

DESIGN

Retrospective analysis.

METHODS

A retrospective study of 8034 cases over 35-years at a single ocular oncology referral center evaluated the primary endpoint of cumulative incidence of metastasis at 5-, 10-, 15-, 20-, 25- and 30-years using non-conditional and conditional analysis at 3-years, 5-years, and 10-years of metastasis-free survival.

RESULTS

The mean thicknesses for small, medium, and large UMs were 2.5 mm, 5.0 mm, and 10.2 mm, respectively. Based on tumor size category (small vs. medium vs. large), the 25-year non-conditional metastasis was 5% vs. 12% vs. 21%, and for those with 3-year metastasis-free survival, the 25-year incidence of metastasis was 7% vs. 13% vs. 26%. For those with 5-year metastasis-free survival, the 25-year incidence of metastasis was 6% vs. 11% vs. 21%. For those with 10-year metastasis-free survival, the 25-year incidence of metastasis was 4% vs. 8% vs. 21%. For small vs. medium UM, by conditional analysis, those who maintained 3-year/5-year/10-year metastasis-free survival, hazard ratio was 1.50 (P <0.01)/1.53 (P <0.01)/1.77 (P = 0.01), and for medium vs. large UM, hazard ratio was 1.45 (P <0.01)/1.44 (P = 0.03)/1.96 (P = 0.06).

CONCLUSION

Long-term comparative analysis of UM metastasis, based on tumor size category (thickness) as small, medium, or large, revealed that large UM is more likely with higher tendency to develop metastasis over time. The patients achieving 3-, 5-, and 10-year metastasis-free survival demonstrated significantly reduced subsequent risk of metastasis across all tumor size categories.

Association Between Visceral Fat Metabolism Score and Cataract Risk in US Adults: National Health and Nutrition Examination Survey 1999 to 2008

PURPOSE

The present work focused on investigating the relation of visceral fat metabolic score (METS-VF) with cataract prevalence among the American adults.

DESIGN

A cross-sectional study.

METHODS

This cross-sectional study, based on the U.S. population, used data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2008. For assessing the association of METS-VF with cataract, we employed multivariable logistic regression analysis, subgroup analyses, and restricted cubic splines (RCS) analysis for exploring their relation. Additionally, receiver operating characteristic (ROC) curve analysis was conducted to compare the cataract diagnostic abilities of METS-VF, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR).

RESULTS

There were altogether 2,730 participants included, of whom 290 had cataract.METS-VF was significantly related to cataract (P < .001). As METS-VF quartiles increased, cataract prevalence also increased (Q1: 1.90%, Q2: 6.74%, Q3: 10.25%, Q4: 23.61%). After adjusting for all variables, METS-VF still showed positive relation to cataract prevalence (odds ratio (OR) = 3.14, 95% confidence interval (CI): 1.67, 5.93). Subgroup analysis revealed a consistent relationship between METS-VF and cataracts across different groups. The RCS results showed that there was no significant nonlinear relationship between METS-VF and cataracts (P-non-linear = 0.209). ROC curve analysis showed that METS-VF outperformed BMI, WC, and WHtR in cataract prediction.

CONCLUSION

METS-VF is significantly positively related to a higher cataract prevalence, and this relationship remains robust across various subgroups. Additionally, METS-VF demonstrates a stronger predictive ability for cataract than BMI, WC, and WHtR.

Tumor Location of Uveal Melanoma and Impact on Metastasis-Free Survival in 1001 Cases

BACKGROUND

There is limited literature on tumor location of uveal melanoma (UM) and the relative impact on metastasis-free survival (MFS).

METHODS

A review of 1001 consecutive eyes with UM was performed and precise tumor location was identified according to quadrant (5 zones), clock hour (13 zones), anteroposterior (5 zones), and a combination of clock hour and anteroposterior regions (49 zones). Heat maps were constructed for frequency in each zone and Kaplan-Meier estimates for 5- and 10-year MFS was calculated.

RESULTS

The UM quadrant regions included central (macula and juxtapapillary) (18%), superior (19%), nasal (18%), inferior (18%), and temporal (27%). The central region demonstrated smaller UM thickness (p < .01) and diameter (p < .01). The MFS (5- and 10-years) for central region (90%, 86%) was more favorable than other quadrants (p < .01).The UM clock hour regions included central (18%), 1:00 (6%), 2:00 (6%), 3:00 (10%), 4:00 (6%), 5:00 (7%), 6:00 (7%), 7:00 (5%), 8:00 (7%), 9:00 (9%), 10:00 (6%), 11:00 (5%), and 12:00 (8%). The central region demonstrated smaller UM thickness (p < .01) and diameter (p < .01). The MFS (5- and 10-years) for central region (90%, 86%) was more favorable than any clock hour region (p = .03).The UM anteroposterior regions included central (18%), post-equatorial (28%), equatorial (26%), peripheral (13%), and ciliary body (15%). Increasing UM thickness (p < .01) and diameter (p < .01) stepwise were noted with increasing anterior location. The MFS (5- and 10-years) for central region (90%, 86%) was more favorable than other anteroposterior regions (p < .01).A combination of clock hour and anteroposterior regions (49 zones) revealed random distribution with no preferential location. Multivariate regression analysis adjusted for tumor thickness/diameter and proximity to foveola/optic disc showed no benefit of any location.

CONCLUSIONS

Across all fundus regions, UM occurred most often in the central region. Uveal melanoma in the central region was smaller in thickness and base and demonstrated more favorable MFS compared to other quadrants, clock hours, and anteroposterior zones. Analysis of the 49 zones showed no benefit of tumor location alone after adjusting for tumor size and proximity to foveola and optic disc.

Multicomponent strategy for optimized peri- and postoperative wound care after open revascularization for peripheral atherosclerosis

OBJECTIVE

Patients who undergo open infrainguinal surgical revascularization are at high risk of surgical wound complications. This study aimed to evaluate the effectiveness of introducing an optimized multicomponent surgical wound management strategy involving preoperative risk stratification of patients, perioperative optimized wound closure and dressing and postoperative edema control.

METHODS

This was a pragmatic pre-post study at a tertiary vascular surgery center. Consecutive patients who underwent surgery from November 2022 to the end of June 2023 (postintervention group) were compared with patients who underwent surgery between November 2021 and the end of June 2022 (preintervention group). The primary outcomes were surgical wound complications (a composite outcome based on prolonged lymphatic secretion or seroma, surgical site infection, bleeding or hematoma and wound dehiscence) during primary admission and within 60 days after surgery. The outcomes are presented as total numbers, and comparisons among groups were performed via logistic regression; the results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). Baseline and perioperative characteristics with potential confounding impacts were controlled for by means of propensity scores and the inverse probability of treatment weights.

RESULTS

In 122 (preintervention group) and 133 (postintervention group) patient cases, a total of 49 (40.8%) and 27 (20.6%) surgical wound complications, respectively, were observed during primary admission, corresponding to an adjusted OR of 0.43 (95% CI 0.24 to 0.77). The length of stay was lower in the postintervention group, with an adjusted average of -1.19 days (95% CI -2.6 days to 0.2 days). During the 60-day follow-up, 38 (31.1%) and 44 (33.1%) patients experienced surgical wound complications, with ORs of 1.18 (95% CI 0.69 to 2.04). Among these, 11 (9%) and 12 (9%) had deep wound complications, with ORs of 0.95 (95% CI 0.40 to 2.28), and 13 (10.7%) versus 18 (13.5%) were readmitted because of wound complications, with ORs of 1.26 (95% CI 0.58 to 2.74).

CONCLUSION

Optimized peri- and postoperative surgical wound management was found to be associated with a reduced risk of surgical wound complications during primary admission, yet the risk of serious wound complications during follow-up remained high.

Climate Change Awareness: Does It Affect the Fertility Desire?

AIM

The primary aim of the study was to explore the impact of women's climate change awareness on fertility desire, while the secondary aim was to explore the factors influencing women's fertility desire.

MATERIAL AND METHODS

The study was performed descriptive and correlational type with 440 women without children between March and October 2023. The women's characteristics form and Fertility Desire Scale and Climate Change Awareness Scale were used for data collection.

RESULTS

The mean age of the women was 26.2 ± 4 years, with 55.2% aged 26 or younger; 54.3% held university degrees, and 93% had health insurance. Findings indicate a significant mean total score of 50.7 ± 7.6 on the Fertility Desire Scale, influenced by education, health insurance, income level, marital duration, and type of marriage. Women with higher education levels and those in couple-initiated marriages reported lower fertility desire. The Climate Change Awareness Scale showed a mean score of 210.8 ± 23.2, with higher awareness among those over 26, employed, and with higher education. Multiple linear regression analysis revealed significant predictors of fertility desire, including marital duration and income level. Notably, climate change awareness negatively correlated with fertility desire, explaining 3.1% of the variance.

CONCLUSIONS

These findings highlight the complex interplay between environmental concerns and reproductive intentions among women, indicating a need for further research in this area.

Pattern of anticoagulation prescription for elderly atrial fibrillation patients with or without severe dementia: A retrospective analysis of patient data

Atrial fibrillation (AF) is a very common type of cardiac arrhythmia. Use of an anticoagulant is highly recommended. We aimed to identify the pattern of prescribing of an oral anticoagulant (OA) in patients with AF and severe dementia or patients with AF aged > 80 years. A retrospective review of medical charts was conducted in 2 tertiary care centers in Riyadh, Saudi Arabia: King Saud University Medical City and King Abdulaziz Medical City. Data for people with AF retrieved between January 2016 and December 2020 from hospital information systems. Collected data included demographics, medical history, medication history (including use of an OA or antiplatelet agent), stroke and major bleeding history. Adjusted binary logistic regression was used to predict the odds ratio (OR) of the primary outcome and secondary outcomes. The data of 620 patients were assessed. Most (60%) were women. The average age of study cohort was 79 ± 6.1 years. Most patients (88.2%) were prescribed an OA. The most commonly prescribed OA was a direct inhibitor of factor Xa (DIFXa; 48%), followed by a coumarin derivative (36%), and direct inhibitor of thrombin (16%). Patients using a coumarin derivative carried higher OR of developing severe dementia (adjusted OR = 2.687, 95%CI = 1.795-4.021, P-value < .001). Most patients suffering from AF were prescribed an OA. A DIFXa inhibitor was the most prescribed OA. Use of a coumarin derivative carried a high prevalence of dementia among our study cohort.

Analysis of prosthetic risk factors for peri-implant medication-related osteonecrosis of the jaw: an observational study

The study aimed to evaluate clinical characteristics of peri-implant medication-related osteonecrosis of the jaw (PI-MRONJ) and to identify prosthetic risk factors for PI-MRONJ. Demographic and pharmacological data were collected from 32 patients. Radiographic assessments were performed to evaluate potential risk factors related to prosthetic elements, including prosthesis margin, embrasure space, emergence profile and angle, span of prostheses, and cantilever extensions. 24 patients were classified as having implant presence-triggered PI-MRONJ, while 8 were categorized as having implant surgery-triggered PI-MRONJ. Even in well-functioning implants, MRONJ developed after an average of 48.3 months following the initiation of anti-resorptive drug (ARD) therapy. Similarly, in implants placed during ARD therapy and showing successful osseointegration, MRONJ occurred after an average of 23.3 months of implant placement. Comparing prostheses in MRONJ-affected areas to those in unaffected areas, the presence of cantilever extensions showed the only significant difference (p = 0.002). Regression analysis revealed that cantilever extensions (p = 0.001), sex (p = 0.009), duration of ARD (p = 0.042), and age (p = 0.046) were significantly associated with PI-MRONJ. These findings suggest that non-axial loading may be a risk factor for PI-MRONJ. Proper prosthetic design and load management, along with long-term monitoring, are crucial for preventing PI-MRONJ.

Fluoride Concentrations in Different Brands of Toothpaste Marketed in Saudi Arabia

OBJECTIVES

This study aimed to evaluate the concentrations of total fluoride (TF), total soluble fluoride (TSF) and ionic fluoride (IF) in various toothpaste brands marketed in Saudi Arabia and compare them with the labelled values.

METHODS

Twenty toothpaste brands were randomly selected from supermarkets and hypermarkets in Riyadh, Saudi Arabia. For each brand, two samples from different production batches were purchased and labelled as sample 1 and sample 2. TF and TSF were determined chemically, while IF was measured with fluoride electrodes. The measured fluoride concentrations were compared with the labelled values and the recommended 1000-1500 ppm range for effective caries prevention.

RESULTS

In total, 40 toothpaste samples were analysed (20 from each of two batches). For TF, six toothpastes in sample 1 exceeded the standard limit of 1500 ppm, with a range of 2102-2462 ppm, while nine in sample 2 surpassed the limit, ranging from 1538 to 1846 ppm. Conversely, eight toothpastes in sample 1 and two in sample 2 were below the minimum recommended level of 1000 ppm, with ranges of 308-923 ppm and 615-923 ppm, respectively. The TSF ranged from 924 to 2157 ppm in sample 1 and 923-2154 ppm in sample 2. The IF varied from 615 to 2462 ppm in sample 1 and 308-2154 ppm in sample 2.

CONCLUSIONS

Most toothpaste brands had fluoride levels within the recommended concentration range. However, a significant number exhibited fluoride levels either below the minimum effective dose or exceeding the maximum recommended limit. Fluoride variance in toothpaste demands awareness for dentists and public health to guide optimal caries prevention.

Gender differences in factors influencing specialty choice in obstetrics and gynecology: A national survey of graduating senior residents

AIM

To analyze gender differences in factors influencing the choice of obstetrics and gynecology as a specialty and to inform gender-specific recruitment strategies for a more diverse and sustainable obstetrics and gynecology workforce.

METHODS

This nationwide cross-sectional survey was conducted annually in Japan from 2019 to 2024, targeting post-senior residency obstetricians and gynecologists. The survey collected data on demographics, timing, reasons for choosing obstetrics and gynecology, and changes in concerns from pre- to post-senior residency.

RESULTS

The survey received 2049 responses out of 2458 distributed surveys, resulting in a response rate of 83.9% (60.6% female, 39.4% male). Moreover, 52.4% of respondents initially considered obstetrics and gynecology during medical school, with females more likely to consider it before medical school than males (24.8% vs. 17.3%). Clinical clerkship experience was the most common reason (57.7%), particularly among females compared to males (62.3% vs. 50.5%). However, males were more influenced by family members or relatives (6.9% vs. 13.1%) and lectures (8.6% vs. 12.6%) than females. Pre-residency concerns-physical burden, mental burden, night on-call demands, marriage and family planning, career path planning, litigation risks, and workforce shortages-were higher in females than in males, although these concerns decreased significantly post-residency, excluding those regarding workforce shortages and income. Male-specific concern about the "need for male physicians" decreased significantly from 32.3% to 11.9%.

CONCLUSIONS

This nationwide survey provides valuable insights into the role of gender in specialty decision-making, with important implications for developing gender-specific recruitment strategies.

Differences in neuroradiological impacts of hematoma volume and midline shift on clinical symptoms and recurrence rate in patients with unilateral chronic subdural hematoma

OBJECTIVE

Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly among the elderly. Hematoma volume (HV) and midline shift (MLS) on CT imaging are critical for assessing CSDH severity and recurrence risk. Brain atrophy has also been linked to recurrence. This study investigates the impact of HV and MLS on clinical symptoms and recurrence, considering brain atrophy.

METHODS

A retrospective analysis was conducted on patients with unilateral CSDH who underwent burr hole surgery for symptoms such as headache, disturbances of consciousness, hemiparesis, and gait disturbance. HV, MLS, and relative cortical atrophy index (RCAI) were measured using preoperative (pre-) and postoperative (post-) CT images. The rate of change in RCAI (RCAI-CR) between pre- and post-CT images was calculated to assess contralateral brain compression. Associations between HV, MLS, RCAI, RCAI-CR, symptoms, and recurrence were analyzed.

RESULTS

The study included 293 patients (mean age 79.4 ± 12.1 years), with a recurrence rate of 15.0 % (44/293). Pre-HV (per 10 mL) was significantly associated with hemiparesis and gait disturbance (odds ratio [OR] 1.12, 95 % confidence interval [CI] 1.03-1.21, p = 0.011; OR 1.14, 95 % CI 1.05-1.24, p = 0.003). Pre-MLS was significantly correlated with disturbances of consciousness (OR 1.26, 95 % CI 1.14-1.39, p < 0.001) and was elevated in patients with high RCAI-CR. Significant predictors of recurrence included Pre-HV (per 10 mL) (OR 1.16, 95 % CI 1.03-1.31, p = 0.014), postoperative subdural cavity volume (per 10 mL) (OR 1.18, 95 % CI 1.02-1.36, p = 0.026), antiplatelet drug use (OR 0.23, 95 % CI 0.06-0.89, p = 0.032), and CT classification (OR 2.35, 95 % CI 1.15-4.82, p = 0.020).

CONCLUSIONS

HV and MLS have distinct clinical implications in CSDH. Pre-HV is linked to motor disturbances, while Pre-MLS correlates with disturbances of consciousness, with high RCAI-CR indicating significant brain compression. HV is a key predictor of recurrence, while MLS and RCAI are not. These findings may improve outcome prediction and management strategies.

Which Sex- and Gender-Based Explanatory Variables Are Associated With Memory Function Poststroke? A Cross-Sectional Analysis of the National Health and Aging Trends Study

OBJECTIVE

To identify sex- and gender-based variables associated with immediate and delayed recall in individuals with stroke.

DESIGN

This was a secondary analysis of data from the National Health and Aging Trends Study (NHATS) using general linear models with a standard stepwise approach.

SETTING

Community.

INTERVENTIONS

Not applicable.

PARTICIPANTS

Participants were eligible for the current analysis if they had a self-reported history of stroke at NHATS Round 1 (2011) and data available on our variables of interest. The final analyses included 366 participants for the immediate recall model and 365 participants for the delayed recall model.

MAIN OUTCOME MEASURES

Independent variables of interest included sex- (8 variables, for example biological sex, depression and anxiety, and comorbidities) and gender-related factors (14 variables, for example education, income, and independence with banking). The dependent variables of interest were the 10-word immediate and delayed recall tests, respectively.

RESULTS

Higher immediate recall scores were associated with younger age, female biological sex, independence with banking, higher income, giving financial gifts, not requiring assistance with activities of daily living, and higher education (P<.001-.04). Higher delayed recall scores were associated with younger age, higher body mass index, higher education, placing importance in socializing, and independence with banking (P<.001-.04).

CONCLUSIONS

We conducted the largest analysis to date of sex- and gender-based factors associated with cognition in individuals with stroke. Stroke rehabilitation scientists and clinicians may consider both biological and sociodemographic factors associated with cognitive function, which may guide holistic poststroke assessments and interventions.

Forgone Care of doctor's visits in Germany - Results from three cross-sectional surveys

BACKGROUND

Forgone care, defined as not using health care despite needing it, leads to adverse outcomes such as increased emergency care use. Our study uses data from German representative surveys (2016, 2021, 2022) to examine the frequency, demographics, and reasons for forgone care.

METHODS

Multiple logistic regression models of individual cohorts and pooled data were used to assess the likelihood of forgoing a doctor's visit. Reasons for forgone care were analyzed descriptively and further clustered in different types of barriers.

RESULTS

Of 10,122 participants, 21 % reported forgone care in the past year: 22 % in 2016, 18 % in 2021, and 20 % in 2022. The likelihood of forgone care is highest among women (OR: 1.22 [1.09; 1.37]) and younger adults aged 18-44 years (OR: 1.19 [1.05; 1.34]), whereas participants in partnerships were less likely to forgo care (OR: 0.77 [0.69; 0.87]). Barriers were categorized as systemic (e.g. waiting time; 39 %), psychological (e.g. fear of diagnosis; 22 %), and physical (e.g. difficulty reaching the doctor; 19 %). Younger adults and members of the workforce cited systemic barriers most often, whereas older adults (65+) cited psychological and physical barriers.

DISCUSSION

Targeted interventions for vulnerable groups are needed that reduce barriers for forgone care. Recommendations include more accessible doctor's offices, improved appointment systems, expanded telemedicine, and flexible hours.

Clinical and mental health characteristics among patients receiving medications for opioid use disorder treatment versus patients receiving low- and high-dose opioids when referred for pain management

OBJECTIVE

To examine the demographic and clinical characteristics of patients attending pain management services who were receiving opioid agonist treatment (ie, methadone or buprenorphine for the treatment of opioid use disorder) in comparison with those taking prescription opioid analgesics in oral morphine equivalent daily doses at low (<40 mg) and high doses (>100 mg) in a national database from the electronic Persistent Pain Outcomes Collaboration (ePPOC) in Australia.

DESIGN

A cross-sectional study.

SETTING

Australian pain services.

SUBJECTS

Adult patients referred to Australian pain service clinics between 2016 and 2021.

METHODS

Multinomial and bivariate logistic regression models were conducted to compare the demographic and clinical characteristics of patients on opioid agonist treatment and those taking other prescription opioid analgesics.

RESULTS

Among 42 182 participants, most were female (56.8%), with a mean age of 51.7 years. People on opioid agonist treatment (n = 1016) and high-dose opioids (n = 7122) were similar in that they both had more severe mental health symptoms and longer pain duration than the low-dose group (n = 20 517). Compared with the high-dose group, people on opioid agonist treatment had reduced odds of reporting more severe pain intensity but increased odds of having multimorbidity, more severe anxiety, and pain catastrophizing thoughts.

CONCLUSIONS

These findings highlight the need for mental health treatment and the necessity of tailored multidisciplinary pain management for people in opioid agonist treatment.

The impact of obesity on functional outcomes in navigation-assisted total hip arthroplasty

INTRODUCTION

Functional outcomes after total hip arthroplasty (THA) are generally poorer in obese patients compared to non-obese individuals. However, the effect of obesity on functional improvement following navigation-assisted HA remains controversial. This study investigates whether BMI influences functional outcome improvements following navigation-assisted THA.

MATERIALS AND METHODS

We reviewed our institutional database from 2010 to 2024 for patients undergoing navigation-assisted unilateral primary THA. Patients were categorized as Healthy weight (18.5-25.0 Kg/m2), Overweight (25.0-29.9 Kg/m2), and Obese (30-39.9 Kg/m2), based on their preoperative BMI. Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) was compared across BMI groups as the primary outcome. Multiple linear regression models were used to investigate the effect of BMI groups on Delta HOOS JR and postoperative HOOS JR while controlling for confounding variables.

RESULTS

A total of 1,543 cases with a mean age of 62.80 years (range: 23-94) were included. Most patients were Overweight (40.5%), followed by Obese (32.9%) and Healthy weight (26.6%). Although obese patients had significantly lower preoperative and postoperative functional scores (p < 0.05), they demonstrated greater improvements in HOOS symptoms (44.68 ± 22.45 vs. 40.68 ± 22.29, p = 0.006) and activities of daily living (46.36 ± 20.85 vs. 42.10 ± 21.20, p = 0.002) compared to the Healthy weight group. Despite obesity being linked to lower postoperative HOOS JR, regression analysis showed age ≥ 60 years, men, and alcohol consumption-but not BMI status-negatively affected Delta HOOS JR.

CONCLUSIONS

The obese group exhibited better improvements in HOOS symptoms and ADL with comparable Delta HOOS JR, supporting navigation-assisted THA as a valuable option for obese patients. The results of this study may help surgeons provide evidence-based preoperative counseling to obese patients regarding the expected clinical outcomes of THA.

The relationship between parental autonomy support, teacher autonomy support, peer support, and university students' academic engagement: the mediating roles of basic psychological needs and autonomous motivation

Objective

This study, based on Ecological Systems Theory and Self-Determination Theory, explores the relationships between parental autonomy support, teacher autonomy support, peer support, and university students' academic engagement from a positive psychology perspective, as well as the mediating roles of basic psychological needs and autonomous motivation.

Methods

A questionnaire survey was conducted with 416 university students from four universities in Guangxi, using the Academic Engagement Scale, Parental Autonomy Support Scale, Teacher Autonomy Support Scale, Peer Support Scale, Basic Psychological Needs Scale, and Learning Motivation Scale.

Results

(1) Teacher autonomy support was significantly positively associated with university students' academic engagement; peer support was significantly negatively associated with academic engagement; parental autonomy support was not significantly associated with academic engagement. (2) Basic psychological needs significantly mediated the relationships between parental autonomy support, teacher autonomy support, peer support, and academic engagement. (3) Autonomous motivation significantly mediated the relationships between parental autonomy support, teacher autonomy support, and academic engagement, while it was not significantly associated with the relationship between peer support and academic engagement. (4) Basic psychological needs and autonomous motivation played a chain-mediating role in the relationships between parental autonomy support, teacher autonomy support, peer support, and academic engagement.

Conclusion

Teacher, parental, and peer support influence university students' academic engagement through different pathways, with basic psychological needs and autonomous motivation serving as important "bridging" factors.

Advance Care Planning Engagement of Older Adults in the Emergency Department

BackgroundAdvance care planning (ACP) helps older adults make end-of-life medical decisions. While ACP discussions are associated with improved patient outcomes, overall engagement remains low in the emergency department (ED).ObjectivesThis study assessed ACP engagement in older ED patients.MethodsWe conducted a questionnaire study among adults ≥65 in a Boston ED (July-Oct 2023). Our primary outcome was ACP Engagement as measured by a validated 9-item instrument with three ACP self- efficacy and six ACP readiness questions. Secondary outcomes included participants' preferences for learning about five ACP topics in the ED-medical decision makers, what matters most, leeway and flexibility for decision makers, sharing wishes, and asking questions)-as well as their favored learning formats (eg, pamphlets, videos, clinician conversations). Each was rated on a 5-point Likert scale. We examined the relationship between ACP engagement and existing electronic health record (EHR) documentation.ResultsNinety-nine older adults participated (mean age 75.5; 53.5% women). On the 9-item ACP Engagement Survey, participants reported high overall scores with a mean of 4.1 (95% CI: 4.0-4.2). Among ACP readiness topics, 80 (81.6%) named a decision-maker; 37 (40.2%) discussed end-of-life wishes with doctors. Participants preferred ED team conversations. Among the 51 participants who reported having signed paperwork regarding end-of-life wishes, only 7 (13.7%) had forms documented in the EHR.ConclusionsAmong older adults in a large Boston-based ED, ACP engagement was high, but few patients had documentation of end-of-life wishes available in the EHR. Findings highlight the need for better ACP documentation in EDs.

Self-reported quality of life of older adults receiving home care: The feasibility and reliability of new items

Proxy rated quality of life (QoL) might mislead the interpretation of QoL of older people. This cross-sectional survey evaluated the reliability and feasibility of using newly developed self-reported QoL items for older adults (≥75 years) receiving home care services. Of the distributed questionnaires, 60.34 % (875/1450) were returned with valid responses in at least one of the QoL items. The largest number of missing data was five cases per question, and the intraclass correlation ranged from 0.47 to 0.77. Furthermore, 66.0 % of those aged 85-94 years, 76.4 % of those with heart failure, and 50 % of those with a terminal medical condition responded to the QoL items. The newly developed items capture the essential aspects of older people's lives and were found to be reliable and feasible for use by older people, including those with terminal conditions, dementia, and a high degree of dependency.

Prostate Cancer Screening Among Traditionally Underserved Populations at a Large Public Safety-Net Institution

BACKGROUND

Existing literature underscores racial and sociodemographic disparities in prostate cancer screening (PCS) in the USA.

OBJECTIVE

To evaluate whether traditional PCS disparities are evident within a health safety-net institution tailored to support traditionally underserved populations.

DESIGN

A retrospective cohort study using electronic health-record data was conducted at an urban safety-net institution.

PARTICIPANTS

Male patients aged 51-70 years with a primary care provider (PCP) visit from 2018 to 2019 were included.

MAIN MEASURES

The primary outcome was PCS, defined as receiving a Prostate Specific Antigen (PSA) blood test within the study period. Investigated patient characteristics included self-reported race and ethnicity, language, insurance, marital status, median household income, serious mental illness (SMI), substance use disorder (SUD), and family history of prostate cancer (PCa). Bivariate analyses using chi-squared tests and multivariable logistic regression analyses were performed to compare PCS rates between the groups.

KEY RESULTS

The cohort included 10,059 men, of which 40.4% had PCS. In total, 57.3% of the study population was of non-White race and 61.4% of non-North American/European ethnicity. A total of 31.2% had limited English proficiency (LEP), 17.8% had SMI, and 13.2% had SUD. In multivariable analysis of race, Black patients (OR 1.96, 95%CI 1.71-2.24, p < 0.001) and Hispanic patients (OR 1.51, 95%CI 1.3-1.76, p < 0.001) had significantly higher odds of PCS than White patients. Patients with LEP did not exhibit significantly lower screening rates than English-speaking patients (ORs 0.99-1.17).

CONCLUSIONS

Within a healthcare institution designed and implemented to meet the needs of underserved populations, traditional racial and sociodemographic disparities in PCS are not evident.

Impact of spinal alignment on adjacent segment disease and degeneration after short-segment lumbosacral fusion

BACKGROUND CONTEXT

Adjacent segment disease (ASDis) and degeneration (ASDeg) are common complications following lumbar fusion, ranging from asymptomatic radiographic changes to debilitating symptoms requiring revision surgery. While the impact of spinopelvic alignment (SPA) on postoperative outcomes and ASDis prevention is well-studied in long-construct fusions, its role in short-segment lumbosacral fusions, particularly over the long term, remains unclear.

OBJECTIVE

This study aimed to investigate the association between global and distal lumbar SPA with the development of ASDis and ASDeg in the long-term follow-up of patients undergoing short-segment lumbosacral fusion. Secondary outcomes were patient reported outcome measures (PROMs) in relation to adjacent segment changes.

STUDY DESIGN/SETTING

Retrospective single-center cohort study with minimum follow-up of 5 years.

PATIENT SAMPLE

A total of 86 patients who underwent L4-S1 spinal fusion between 2003 and 2015, with a mean follow-up of 12±4 years.

OUTCOME MEASURES

The primary outcome was the development of adjacent segment changes, classified into 2 groups: (1) surgically-treated ASDis, and (2) ASDeg, defined as radiographic evidence of adjacent segment changes without surgical intervention. Secondary outcomes included PROMs: the Oswestry Disability Index (ODI) and the European Quality of Life 5 Dimensions 5 Level (EQ5D5L).

METHODS

Pre- and postoperative standing radiographs were annotated and the following global lumbar SPA parameters analyzed: Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), PI-LL-mismatch, lumbar pelvic angle (LPA). Additionally, the following distal lumbar SPA parameters were analyzed: Distal lordosis (DL) between L4-S1, lordosis distribution index (LDI=DL/LL), PI-DL-difference, DL-PI-ratio, adjacent segment lordosis (ASL). Postoperative ODI and EQ5D5L were assessed via a telephone interview.

RESULTS

Among 86 patients with a mean follow-up of 12±4 years the incidence of ASDis was 27.9% (n=24), while 7.0% (n=6) showed ASDeg. No significant differences in pre- and postoperative global lumbar SPA were found in patients who developed ASDis or ASDeg compared to patients who did not. PI (53.6° vs. 59.6°) and preoperative SS (34.9° vs. 40.3°) trended to be lower in the ASDis group compared to controls, although non-significant. Pre- and postoperative distal lumbar SPA parameters did not differ between groups. Patients with adjacent segment changes, regardless of whether they underwent revision surgery, reported worse PROMs. ODI scores were elevated in both the ASDis group (28, IQR 15-42) and the ASDeg group (34, IQR 14-47) compared to controls (10, IQR 2-24; p=.005). EQ5D5L scores were lower in both the ASDis (70, IQR 53-83) and the ASDeg groups (60, IQR 55-85) compared to controls (85, IQR 75-90; p=.025).

CONCLUSION

In this long-term follow-up study of patients undergoing short-segment lumbosacral fusion, neither preoperative nor postoperative SPA was significantly associated with the development of ASDis or ASDeg. These findings suggest that other factors may have a greater influence on ASDis risk. Patients who developed adjacent segment changes, whether or not they required revision surgery, experienced worse long-term postoperative PROMs, indicating the importance of ASDis prevention.

Does Management of Postoperative Nausea and Vomiting Differ by Patient Demographics? An Evaluation of Perioperative Anesthetic Management-An Observational Study

BACKGROUND

Disparities in postoperative nausea and vomiting and its prophylaxis may exist based on race, ethnicity, and socioeconomic status. The objective was to evaluate whether patients from racial and ethnic minority groups and patients from lower socioeconomic status backgrounds received less appropriate postoperative nausea and vomiting prophylaxis and experienced higher rates of postoperative and postdischarge nausea and vomiting.

METHODS

This retrospective cohort study included 23,333 adults who underwent major surgeries (total knee arthroplasty, cholecystectomy, hysterectomy, and prostatectomy) from 2017 to 2022 in a single, multistate hospital system. Outcomes included prophylactic antiemetic administration according to consensus guidelines, as well as the occurrence of postoperative and postdischarge nausea and vomiting, with predictors being patient race and ethnicity, payor type, and community-level socioeconomic status.

RESULTS

About 45% (n = 10,407) of patients received guideline-recommended postoperative nausea and vomiting prophylaxis. Regression models showed statistically significant differences in appropriate postoperative nausea and vomiting prophylaxis by race and ethnicity, as well as community-level socioeconomic status, with Black (odds ratio, 0.76; 95% CI, 0.63 to 0.92) and Hispanic (odds ratio, 0.82; 95% CI, 0.70 to 0.96) patients having lower odds of receiving appropriate antiemetic prophylaxis compared to non-Hispanic White patients. Approximately 11% of patients (n = 2,522) experienced postoperative nausea and vomiting in the postanesthesia care unit, and about 19.5% of patients (n = 4,540) experienced postdischarge nausea and vomiting. No significant differences in postoperative nausea and vomiting were observed in the postanesthesia care unit among different groups; however, Black, Hispanic, other races and ethnicities, and patients with Medicaid had higher odds of postdischarge nausea and vomiting.

CONCLUSIONS

The study identified differences in appropriate postoperative nausea and vomiting prophylaxis by race and ethnicity, as well as community-level socioeconomic status. There were no differences in postoperative nausea and vomiting by the predictors, but there were higher odds of postdischarge nausea and vomiting by race and ethnicity and payor. This study underscores the importance of data stratification in quality measures to identify disparities in perioperative care; it can lead to changes in perioperative anesthetic management. Further research should explore these associations in a broader cohort and address potential confounding sources.

Systemic inflammation in asymptomatic hyperuricaemia with sonographic crystal deposits, including a comparison with normouricaemia and gout

OBJECTIVE

To describe the inflammatory profile of asymptomatic hyperuricaemia (AH) with ultrasound evidence of monosodium urate (MSU) crystals (AH-MSUpos), vs AH without deposits (AH-MSUneg), intercritical gout and normouricaemia.

METHODS

Based on serum urate levels, musculoskeletal ultrasound and history of flares, we divided 122 participants into four groups: normouricaemia, AH-MSUneg, AH-MSUpos and intercritical gout. We tested four ultrasound definitions for MSU deposition in AH: grade 2-3 (G2-3) double contour and/or tophi, G1-3 double contour and/or tophi, G1-3 Stewart scheme (double contour sign in knee cartilage and/or first metatarsophalangeal joint and/or tophi in first metatarsophalangeal joint) and G2-3 Stewart scheme. Serum acute phase reactants, cytokines, pyroptosis derivates and neutrophil-related proteins were measured and compared between groups. A linear regression model was fitted to correlate crystal and inflammatory burden (measured by ultrasound) with inflammatory markers in hyperuricaemics.

RESULTS

Rates of MSU deposition in AH ranged from 26.0% to 68.8%, depending on the definition used. Levels of CRP, leukocytes, IL-1RA, IL-6, sIL-6R, IL-18, TNF-α, TGF-β and galectin-3 were higher in hyperuricaemics vs normouricaemics. Sex, obesity and comorbidity scores influenced some comparisons. We saw no differences comparing AH-MSUposvs AH-MSUneg groups, except for higher calprotectin using G1-3 sonographic definitions and higher CRP and TGF-β when restricted to women and obese participants.

CONCLUSIONS

Hyperuricaemia is associated with substantial inflammation and some degree of active pyroptosis. Four different ultrasound definitions for AH with MSU deposits yielded similar findings, although we noted some differences in calprotectin, CRP, and TGF-β. Sex, obesity, and comorbidities influenced some inflammatory responses.

Ethnic variations in neutrophil count as predictors of prognosis following acute myocardial infarction

AIMS

Elevated neutrophils are associated with a poor prognosis after acute myocardial infarction (AMI) but it is not known if ethnicity influences the association between neutrophil count and outcome. We aimed to describe the temporal dynamics of neutrophils after AMI, and assess the interaction between ethnicity, neutrophil count, and outcomes after AMI.

METHODS

Consecutive patients presenting with AMI between 2016 and 2023 were divided into two groups according to their median neutrophil count. Ethnicity was dichotomised as white and other ethnic groups combined (referred to as 'ethnic minorities'). The primary outcome was in-hospital mortality, with a secondary outcome of 60-day mortality.

RESULTS

In our study of 3062 AMI patients (76 % white, 24 % from ethnic minority groups), we found that neutrophil counts rose early post AMI, which coincided with a nadir of the other cell groups. We identified a relative baseline neutropenia in ethnic minority individuals, compared to white individuals (6.85 vs 8.42 × 109/L). We observed a significant, independent association between elevated neutrophils at baseline and the primary outcome of in-hospital mortality (OR 2.06, p < 0.001) and secondary outcome of 60-day all-cause mortality (HR 1.08, p = 0.002). Sub-group analysis revealed a significant interaction between ethnicity and elevated neutrophils (p = 0.004), indicating that a comparable neutrophil count conferred an increased risk for ethnic minority patients for both outcomes.

CONCLUSIONS

We report ethnicity-specific leucocyte dynamics after AMI. Furthermore, neutrophil count is associated with a disproportionate risk in ethnic minority compared with white individuals. Understanding post-AMI inflammation and its interaction with ethnicity is essential in providing personalised prognostication and patient management.

Predictive Factors of ART Follow-Up Loss in HIV Patients (2018-2022): A Retrospective Cohort Study

Loss to follow-up (LTFU) in antiretroviral therapy (ART) poses significant challenges in the management of HIV/AIDS. This study aims to identify socio-demographic and clinical factors influencing LTFU among patients undergoing ART in Luzhou, China, and to develop a predictive model for LTFU using Cox risk regression analysis. In this retrospective cohort study, data from 8,770 patients diagnosed with HIV infection between January 1, 2018 and December 31, 2022 who were enrolled in the national free ART program were analyzed. The primary outcome was the first occurrence of LTFU. Cox proportional risk regression analyses were conducted to identify predictors of LTFU. The study population had a median age of 64.25 years, and 73.2% were male. The overall LTFU rate was 4.14 per 100 person-years. Factors associated with a decreased likelihood of LTFU included female gender, homosexual transmission, absence of HIV-related diseases, negative HBV surface antigen, higher final CD4 count, and an increase in CD4 count from baseline. In contrast, older age, longer time from diagnosis to ART initiation, higher baseline viral load, missed medication doses, and the development of medication side-effects were associated with an increased risk of LTFU. Our prediction model identifying the risk of loss to follow-up demonstrated good predictive performance with a C-index of 0.721. The study highlights the importance of considering a range of socio-demographic and clinical factors in managing LTFU among people living with HIV (PLHIV) on ART. Our prediction model can be a valuable tool for healthcare providers to identify patients at high risk of LTFU, facilitating targeted interventions to improve treatment adherence and outcomes.

Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

BACKGROUND

This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement.

METHODS

This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014-2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures.

RESULTS

Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %).

CONCLUSION

Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.

Currently Available Radiology-Specific Reporting Guidelines

The aim of this paper is to contextualize and review reporting guidelines available at the EQUATOR Network that are most relevant to radiology-specific investigations. Eight EQUATOR Network reporting guidelines for the clinical area of radiology, not including the subspecialized areas of imaging of the cardiovascular, neurologic, and oncologic diseases are reviewed and discussed. The reporting guidelines are for diagnostic and therapeutic clinical research. Why the reporting guideline was development, by whom, their aims and what they hope to achieve are discussed. A table summarizes what the reporting guideline is provided for; an acronym if present is given; a full bibliographic reference with PMID number; the reporting guideline website URL or link; the study design and section of the report that the guideline applies to; and the date that the reporting guideline was last updated.

Safety Outcomes of Antiplatelet Therapy During Endovascular Treatment of Tandem Lesions in Acute Ischemic Stroke Patients

Risk of hemorrhage remains with antiplatelet medications required with carotid stenting during endovascular therapy (EVT) for tandem lesion (TLs). We evaluated the safety of antiplatelet regimens in EVT of TLs. This multicenter study included anterior circulation TL patients from 2015 to 2020, stratified by periprocedural EVT antiplatelet strategy: (1) no antiplatelets, (2) single oral, (3) dual oral, and (4) intravenous IV (in combination with single or dual oral). Primary outcome was symptomatic intracranial hemorrhage (sICH). Secondary outcomes were any hemorrhage, favorable functional status (mRS 0-2) at 90 days, successful reperfusion (mTICI score ≥ 2b), in-stent thrombosis, and mortality at 90 days. Of the total 691 patients, 595 were included in the final analysis. One hundred and nineteen (20%) received no antiplatelets, 134 (22.5%) received single oral, 152 (25.5%) dual oral, and 196 (31.9%) IV combination. No significant association was found for sICH (ref: no antiplatelet: 5.7%; single:4.2%; aOR 0.64, CI 0.20-2.06, p = 0.45, dual:1.9%; aOR 0.35, CI 0.09-1.43, p = 0.15, IV combination: 6.1%; aOR 1.05, CI 0.39-2.85, p = 0.92). No association was found for parenchymal or petechial hemorrhage. Odds of successful reperfusion were significantly higher with dual oral (aOR 5.85, CI 2.12-16.14, p = 0.001) and IV combination (aOR 2.35, CI 1.07-5.18, p = 0.035) compared with no antiplatelets. Odds of excellent reperfusion (mTICI 2c/3) were significantly higher for cangrelor (aOR 4.41; CI 1.2-16.28; p = 0.026). No differences were noted for mRS 0-2 at 90 days, in-stent thrombosis, and mortality rates. Administration of dual oral and IV (in combination with single or dual oral) antiplatelets during EVT was associated with significantly increased odds of successful reperfusion without an increased rate of symptomatic hemorrhage or mortality in patients with anterior circulation TLs.

Available questionnaires do not cover important aspects of quality of life of patients with cutaneous T-cell lymphoma: evaluation of the quality of life of Polish patients with cutaneous T-cell lymphoma

Introduction

Cutaneous T-cell lymphoma (CTCL) has a significant impact on patients' quality of life (QoL). Most studies have measured QoL using validated questionnaires that are not specific to patients with CTCL. Furthermore, clinician-perceived QoL in CTCL patients has never been measured before.

Aim

The quantitative and qualitative evaluation of QoL of the Polish CTCL patients and doctors and checking the impact of the disease on their daily functioning.

Material and methods

Structured anonymous questionnaires were administered to Polish patients diagnosed with CTCL and their physicians. The questionnaire was designed on the basis of interviews with two physicians, experts in the field, and 2 patients. Patients completed the questionnaire and the Skindex-29 survey in person.

Results

Our patients have been moderately affected in the physical domain and significantly affected in the emotional and functional domains according to Skindex-29, whereas according to the results of our questionnaire, the most affected domains are the physical and emotional domains. The biggest inconvenience for patients is commuting to another city and time spent on visits and tests. We are the first to report that 57% of patients try to distract themselves from thinking about the diagnosis, 55% hope for a normal life and 64% miss previous lifestyle and/or opportunities.

Conclusions

Polish physicians underestimated the impact of the disease on insomnia, sleep disturbance and patient independence. Although the Skindex-29 is a widely used and validated tool, it may not fully capture all aspects of QoL in patients with CTCL.

Understanding Unmet Healthcare Needs in Nigeria: Implications for Universal Health Coverage

Background

Many individuals in low- and middle-income countries with healthcare needs do not access the necessary, often lifesaving healthcare services. Existing universal health coverage (UHC) indicators do not account for a portion of the population with unmet healthcare needs.

Objective

To estimate the prevalence, wealth-related inequality, and determinants of unmet healthcare needs in Nigeria using data from the nationally-representative Nigeria Living Standards Survey, 2018-2019.

Methods

We analyzed data from a cross-sectional sample of 116 320 Nigerians from 22 110 households selected using multi-stage probability sampling. The outcome variable was self-reported unmet healthcare needs. We conducted concentration index (CIX) analyzes to assess wealth-related inequalities and performed multilevel logistic regression analysis to identify the determinants of unmet healthcare needs at the individual, household, and community levels.

Results

The prevalence of unmet healthcare needs was 5.2% (95% CI: 5.0-5.5), representing about 11 million Nigerians (95% CI: 10.5-11.5 million). The most common reasons were high costs (unaffordability) and the perception that the illness or injury was not serious. Wagstaff-normalized CIX for unmet healthcare needs was pro-poor: -0.09730 for the general population and -0.10878 for those with chronic illnesses. Significant determinants of unmet healthcare needs include age (AOR: 0.99, 95% CI: 0.99-1.00), chronic illness (AOR: 8.73, 95% CI: 7.99-9.55), single-person households (AOR: 1.55, 95% CI: 1.20-2.02), poorest quintile households (AOR: 1.45, 95% CI: 1.19-1.78), and mildly (AOR: 1.17, 95% CI: 1.01-1.36) or moderately food-insecure households (AOR: 1.30, 95% CI: 1.11-1.51).

Conclusion

A significant proportion of Nigerians, particularly the very poor, chronically ill, those living alone, or food insecure, have unmet healthcare needs. This highlights the necessity for targeted interventions to ensure vulnerable populations can access essential healthcare services. To progress toward UHC, the Nigerian health system must address critical issues related to healthcare accessibility.

Machine Learning of Smoking Relapse: the Role of Racial Differences and E-Cigarette Vaping Characteristics on Former Smokers

BACKGROUND

Machine learning models can help identify multifaceted factors influencing tobacco use transitions. A random forest model is developed to predict smoking relapse, focusing on racial differences and vaping characteristics.

METHODS

Data are drawn from the Population Assessment of Tobacco and Health (PATH) study adult interview files. Former combustible cigarette smokers at baseline (Wave 5) were followed up 1 year later (Wave 6). Predictors (n = 100) include a wide range of social demographics, psychosocial factors, health status, tobacco and substance use behaviors, and vaping characteristics.

RESULTS

Among 4693 former smokers at baseline, 4.4% relapsed to smoking within 4 years. Random forest models achieved high prediction accuracies across racial groups, with area under the curve (AUCs) of 0.77 for Whites, 0.88 for Blacks, and 0.70 for Hispanics. Quit history (i.e., recent vs. long-term quitters) was one of the top predictors across all racial and ethnic groups. Tobacco addiction was one of the top predictors among White and Hispanic former smokers but not among their Black and other race counterparts. Marijuana use was one of the top predictors for Blacks but not for other racial and ethnic individuals. Vaping status predicted relapse across all groups, but the importance of vaping characteristics differed. E-cigarette nicotine concentration levels and e-cigarette devices ranked higher for Whites and Hispanics than for Blacks and Others.

CONCLUSIONS

The findings reveal notable racial differences in smoking relapse predictors, along with distinct roles of vaping characteristics across racial groups. Unique social, behavioral, and health factors are crucial for improving smoking cessation outcomes.

Metabolomic Profiles of Oral Rinse Samples to Distinguish Severe Periodontitis Patients From Non-Periodontitis Controls

AIMS

To explore the potential of metabolomic profiles of oral rinse samples to distinguish between patients with severe periodontitis (stage III/IV) and non-periodontitis controls. This is coupled to an analysis of differences in metabolomic profiles between individuals without periodontitis, patients with localized periodontitis, and patients with generalized periodontitis.

METHODS

Periodontitis patients and controls were recruited, all aged ≥ 40 years. Study participants were asked to rinse vigorously for 30 s with 10 mL phosphate buffered saline. Metabolites were identified using a semi-targeted liquid chromatography tandem mass spectrometry (LC-MS/MS) platform.

RESULTS

In total, 38 periodontitis patients (18 localized, 20 generalized stage III/IV periodontitis patients) and 16 controls were included. Metabolomic profiles of oral rinse samples were able to distinguish patients with severe periodontitis (stage III/IV) from non-periodontitis controls. Among various variables for the severity of periodontitis, we found that the number of sites with deep pockets (PPD) ≥ 6 mm explained best the differences in metabolomic profiles between controls and patients with severe periodontitis. Subjects with a high number of sites with PPD ≥ 6 mm were characterized by a higher level of phosphorylated nucleotides, amino acids, peptides, and dicarboxylic acids. Metabolomic profiles were also significantly different between controls vs. generalized periodontitis and between localized periodontitis vs. generalized periodontitis (p < 0.05).

CONCLUSION

Our study demonstrates that simply collected oral rinse samples are suitable for LC-MS/MS based metabolomic analysis. We show that a metabolomic profile with a substantial number of metabolites can distinguish severe periodontitis patients from non-periodontitis controls. These observations can be a basis for further studies into screening to identify subjects with the risk of having severe periodontitis.

Real-world evaluation of treatment patterns and clinical outcomes in patients with BRAF-V600E metastatic colorectal cancer (mCRC) in Canada

BACKGROUND

BRAF V600E mutations are identified in 10 % of metastatic colorectal cancer (mCRC) cases. In this project, we evaluated the clinicopathologic features and natural history of patients with BRAF mutant (BRAF-mt) mCRC prior to era of BRAF targeted therapy.

METHODS

This is a retrospective project evaluating patients with diagnosed with mCRC with an identified BRAF V600E mutation between January 1, 2015 and December 31, 2021 seen at the Ottawa Hospital Cancer Centre prior to the approval of cetuximab and encorafenib in Canada. Demographic, clinical, and cancer characteristics were collected from the medical records. Outcomes of interest included overall survival (OS) and time to next therapy (TNT).

RESULTS

71 patients were included. The median age was 69 years, 37 (52 %) patients were females, and 19 (27 %) were mismatch repair deficient (dMMR). Median OS was 12.9 months with 21 (30 %) patients living greater than 2-years. Signet ring histology (HR=7.27, p < 0.001), peritoneal metastasis (HR=2.29, 0.003), distant lymphatic metastasis (HR=2.70, p < 0.001), brain metastasis (HR=2.86, p < 0.048) and metastatectomy (HR=0.17, p < 0.001) were associated with OS. Forty-six (65 %) patients received first-line systemic therapy, 14 (20 %) second-line and 2 (3 %) third-line. Median duration of therapy was 8.5 months for first-line, 5.5 months for second-line and 1.5 months for third-line.

CONCLUSION

Real world data demonstrates that patients with BRAF-V600E mCRC have poor clinical outcomes with traditional systemic therapies. Only a minority of patients received second- or third-line systemic treatments, highlighting the importance of ongoing research evaluating incorporation of targeted therapy in first-line treatment.

Mind the gap: pre-operative diastasis recti increases trocar site hernia risk after laparoscopic cholecystectomy

PURPOSE

Trocar site hernias impact 1-10% of patients undergoing a laparoscopic cholecystectomy, typically at the 10 mm port site. Risk factors identified for trocar site hernias include obesity and age; however, little is known about the impact of pre-existing diastasis rectus abdominus (DRA) on trocar site hernia rates. Therefore, we aimed to determine the impact of pre-operative DRA on trocar site hernia rates after laparoscopic cholecystectomy.

METHODS

We conducted a retrospective review of patients undergoing a laparoscopic cholecystectomy for benign gallbladder disease at a single institution from January 2010 to May 2020. CT scan review was used to determine the presence of pre-operative DRA and to diagnose trocar site hernia. Logistic regression was used to determine the factors associated with development of a trocar site hernia.

RESULTS

Of the 2,460 patients who underwent a laparoscopic cholecystectomy, 545 (22%) had both a pre- and post-operative CT scan and were included in analysis, with a 1.5 year median length of follow-up. Overall, 434 patients (80%) had pre-operative DRA and 88 patients (16%) developed a trocar site hernia. On logistic regression, presence of DRA was significantly associated with development of a trocar site hernia (OR = 4.12, 95% CI=[1.72,12.24], p = 0.004), while controlling for location of 10 mm port, BMI, age, sex, ASA classification, smoking status, whether surgery was elective, and presence of pre-operative umbilical hernia.

CONCLUSIONS

Radiologic diagnosis of both DRA and a trocar site hernia is highly prevalent within patients who undergo a laparoscopic cholecystectomy. Further, the presence of pre-operative DRA is significantly associated with development of a trocar site hernia after laparoscopic cholecystectomy.

High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-II Receptor Blockers (ARBs) Initiators

Objective

Angiotensin-II Receptor Blockers (ARBs) are commonly prescribed; however, their adverse events may prompt new drug prescription(s), known as prescribing cascades. We aimed to identify potential ARB-induced prescribing cascades using high-throughput sequence symmetry analysis.

Methods

Using claims data from a national sample of Medicare beneficiaries (2011-2020), we identified new ARB users aged ≥66 years with continuous enrollment ≥360 days before and ≥180 days after ARB initiation. We screened for initiation of 446 other (non-antihypertensive) 'marker' drug classes within ±90 days of ARB initiation, generating sequence ratios (SRs) reflecting proportions of ARB users starting the marker class after versus before ARB initiation. Adjusted SRs (aSRs) accounted for prescribing trends over time, and for significant aSRs, we calculated the naturalistic number needed to harm (NNTH); significant signals were reviewed by clinical experts for plausibility.

Results

We identified 320,663 ARB initiators (mean ± SD age 76.0 ± 7.2 years; 62.5% female; 91.5% with hypertension). Of the 446 marker classes evaluated, 17 signals were significant, and three (18%) were classified as potential prescribing cascades after clinical review. The strongest signals ranked by the lowest NNTH included benzodiazepine derivatives (NNTH 2130, 95% CI 1437-4525), adrenergics in combination with anticholinergics, including triple combinations with corticosteroids (NNTH 2656, 95% CI 1585-10074), and other antianemic preparations (NNTH 9416, 95% CI 6606-23784). The strongest signals ranked by highest aSR included other antianemic preparations (aSR 1.7, 95% CI 1.19-2.41), benzodiazepine derivatives (aSR 1.18, 95% CI 1.08-1.3), and adrenergics in combination with anticholinergics, including triple combinations with corticosteroids (aSR 1.12, 95% CI 1.03-1.22).

Conclusion

The identified prescribing cascade signals reflected known and possibly under-recognized ARB adverse events in this Medicare cohort. These hypothesis-generating findings require further investigation to determine the extent and impact of these prescribing cascades on patient outcomes.

Assessment of Trigeminal Nerve Root Demyelination in Patients with Primary Trigeminal Neuralgia Using Macromolecular Proton Fraction Imaging

BACKGROUND AND PURPOSE

Primary trigeminal neuralgia (PTN) is a prevalent chronic pain disorder. This condition is believed to be associated with demyelination of the trigeminal nerve. Previous studies in this field have focused on diffusion tensor imaging, which has limited sensitivity and specificity to myelin. In the present study, we assessed the trigeminal nerve root via the macromolecular proton fraction (MPF) mapping technique. MPF demonstrated strong correlations with myelin histology in a number of earlier animal studies and is currently viewed as a promising clinical myelin biomarker.

MATERIALS AND METHODS

We performed a prospective case-control study. Fifty-six patients with unilateral PTN and 27 healthy controls were included. All participants were evaluated by using high-resolution brain MR imaging, which included the MPF technique. MPF values from different parts of the trigeminal nerve root, such as the root entry zone (REZ) and central and lateral cisternal segments, were extracted. ANCOVAs were performed. Correlations between MPF values and Sindou grade, duration, and intensity of symptoms were also evaluated in patients with PTN.

RESULTS

A statistically significant decrease in the average MPF of the affected trigeminal nerve root was observed in the PTN group compared with the healthy control group (P < .01, false discovery rate [FDR] corrected). Specifically, reductions in the MPF values of the REZ and central cisternal parts of the affected trigeminal nerve root were found in patients with PTN (P < .01 and P < .05, respectively, FDR corrected). Furthermore, we identified a decrease in the average and REZ MPF values on the affected side compared with the contralateral side in patients with PTN (P < .05 and P < .001, respectively, FDR corrected). A negative correlation between MPF values in the REZ and Sindou grade was revealed (R = -0.35, adjusted P < .05).

CONCLUSIONS

Our preliminary results suggest that MPF could serve as a new neuroimaging biomarker of trigeminal nerve root impairment in patients with PTN and enable noninvasive detection of nerve root demyelination.

Development of a Reporting Guideline for Trochim's Concept Mapping

Reporting guidelines are created with the intention to enhance the quality and transparency of reporting different research methods. Trochim's concept mapping (often referred to as group concept mapping) is a six-phase, participatory mixed-method approach to understanding complex constructs. Currently, there is no reporting guideline for concept mapping. Developing a reporting guideline typically follows a three-step process: 1. a systematic review to establish the need for a reporting guideline, 2. a Delphi study to identify candidate items, and 3. consolidation process to inform a draft guideline. We have previously reported our step 1, a systematic review of health-related concept mapping studies. In this paper, we report on steps 2 and 3, guideline development. In developing our reporting guideline, we opted to use concept mapping rather than the Delphi method. Stakeholders including researchers and experts in concept mapping were identified from papers included in our systematic review and invited to participate. Thirty-two stakeholders participated in the brainstorming phase of the concept mapping generating 96 discrete statements. The prioritisation and clustering phase involved 24 stakeholders. The final concept map included 11 clusters that represented key concepts for inclusion in the reporting guideline. The clusters were relatively small and positioned in a circle around the edge of the map, suggesting each was of equal importance and conceptually discreet. In phase 3, a guideline was drafted using the findings from both the phase 1 systematic review and phase 2 concept mapping study. The draft was reviewed by eight stakeholders (who had participated in our phase 2 concept mapping study) to check the completeness and clarity of expression of the items included in the guideline. The final reporting guideline (called the ConMapT) has 27-items organised under 14 headings. The guideline will be made freely available via the EQUATOR network. Registration: The study protocol was registered with the Open Science Framework (OSF) before recruiting the first study participant. The EQUATOR network has listed the study as a guideline under development.

High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-Converting Enzyme Inhibitor Initiators

PURPOSE

Angiotensin-converting enzyme inhibitors (ACEIs) are commonly prescribed, but their adverse effects may prompt new drug prescription(s), known as prescribing cascades (PCs). We aimed to identify potential ACEI-induced PCs using high-throughput sequence symmetry analysis.

METHODS

Using claims data from a national sample of Medicare beneficiaries (2011-2020), we identified new ACEI users aged ≥ 66 years with continuous enrollment ≥ 360 days before and ≥ 180 days after ACEI initiation. We screened for initiation of 446 other (non-antihypertensive) "marker" drug classes within ±90 days of ACEI initiation, generating sequence ratios (SRs) reflecting proportions of ACEI users starting the marker class after versus before ACEI initiation. Adjusted SRs (aSRs) accounted for prescribing trends over time. For significant aSRs, we calculated the naturalistic number needed to harm (NNTH), and significant signals underwent clinical review for plausibility.

RESULTS

We identified 308 579 ACEI initiators (mean age 76.1 ± 7.5 years; 59.6% female; 88.6% with hypertension). Of 446 marker classes evaluated, 81 signals were significant, and 42 (52%) classified as potential PCs after clinical review. The strongest signals ranked by lowest NNTH included corticosteroids (NNTH 313; 95% CI, 262-392) and serotonin type 3 (5-HT3) antagonists (NNTH 496; 95% CI, 392-689); the strongest signals ranked by highest aSR included sympathomimetics (aSR, 1.97; 95% CI, 1.10-3.53) and other antianemic preparations (aSR, 1.87; 95% CI, 1.31-2.67).

CONCLUSION

Identified prescribing cascade signals were indicative of known and possibly underrecognized ACEI adverse events in this Medicare cohort. The findings are hypothesis-generating and require further investigation to determine the extent and impact of the identified PCs on health outcomes.

Metastasis-free survival of uveal melanoma by tumour size category based on The Cancer Genome Atlas (TCGA) classification in 1001 cases

BACKGROUND

Uveal melanoma (UM) can be classified by tumour size category and by The Cancer Genome Atlas (TCGA) groups (cytogenetic-based, 4-category prognostic classification into Groups A-D). This study was conducted to assess impact on metastasis-free survival (MFS) in UM by tumour size category based on correlation with TCGA classification.

METHODS

Retrospective analysis of 1001 cases categorised as small (0.0-3.0 mm), medium (3.1-8.0 mm) and large (≥8.1 mm), grouped by TCGA classification.

RESULTS

Of 1001 cases, TCGA Groups (A/B/C/D) included small (n = 270, 75%/11%/13%/1%), medium (n = 503, 46%/14%/27%/13%) and large (n = 228, 23%/19%/38%/20%) UM. The 5-and 10-year Kaplan-Meier MFS for small UM revealed Group A (98%, 98%), Group B (100%, 100%), Group C (86%, NA) and Group D (100%, NA). For medium UM, the values dropped with Group A (95%, 93%), Group B (90%, 90%), Group C (68%, 38%), and Group D (44%, NA). For large UM, the values dropped further with Group A (94%, 86%), Group B (85%, NA), Group C (40%, 28%), and Group D (23%, NA). Additionally, a comparison (small vs. medium vs. large tumour size category) revealed TCGA low-risk grouping (Groups A or B) in 86% vs. 60% vs. 58% cases with UM.

CONCLUSION

By tumour size category, favourable cytogenetics (Groups A or B) is found in 86% of small tumours, 60% of medium tumours, and 58% of large tumours. The MFS at 10 years for favourable cytogenetics was 98% for small tumours, 92% for medium tumours, and 54% for large tumours. Tumour size category can serve as a surrogate for TCGA.

Feasibility of the absolute quantification and left ventricular segmentation of cardiac sympathetic innervation in wild-type transthyretin amyloidosis cardiomyopathy with [123I]-MIBG SPECT/CT: The I-NERVE study

BACKGROUND

Cardiac sympathetic neuronal dysfunction is an early marker in wild-type transthyretin amyloidosis cardiomyopathy (ATTRwt-CM). Iodine-123-labeled norepinephrine analog meta-iodobenzylguanidine ([123I]-MIBG) imaging evaluates cardiac sympathetic innervation but lacks volumetric activity quantification in current methods. This study aims to quantify cardiac sympathetic neuronal dysfunction in ATTRwt-CM using [123I]-MIBG single-photon emission computed tomography/ computed tomography (SPECT/CT) and correlate findings with functional and structural cardiac parameters from echocardiogram and cardiac magnetic resonance imaging (CMR).

METHODS

We conducted a single-center, descriptive, cross-sectional study to quantify absolute myocardial sympathetic function in ATTRwt-CM using [123I]-MIBG SPECT/CT. Retrospective reconstruction allowed for absolute tracer-uptake quantification of the left ventricle, overall and segmented, in kBq/mL, standard uptake value (SUV), and percentage of the injected dose (%ID). Echocardiography, CMR, and bone scintigraphy were performed according to clinical standards. Segmented [123I]-MIBG SPECT/CT values were correlated with global longitudinal systolic strain (GLSS) on echocardiography, native-T1, and extracellular volume (ECV) on CMR using SPECT/CT fused with CMR.

RESULTS

Twenty-nine ATTRwt-CM patients (75.8 ± 6.6 years, 90% male) were prospectively included. All exhibited cardiac sympathetic neuronal dysfunction, with a median late heart-to-mediastinum ratio of 1.69 (1.45-1.89) and a washout rate of 22.7% (16.4%-27.3%). SUVmean, SUVpeak, SUVmax, and %ID were 1.80 ± .78, 3.84 ± 1.41, 4.46 ± 1.68, and .46 ± .18, respectively, correlating with semiquantitative [123I]-MIBG measures. No correlations were found with GLSS on echocardiography or native T1 and ECV on CMR.

CONCLUSIONS

The current study demonstrates the feasibility of volumetric quantification of [123I]-MIBG SPECT/CT in ATTRwt-CM. SUVmean, SUVpeak, SUVmax, and %ID correlate with semi-quantitative measures but not with key cardiac parameters on echocardiography or CMR. This confirms the sensitivity of [123I]-MIBG SPECT/CT to different aspects of cardiac function or pathology.

TRIAL REGISTRATION

EudraCT ref. 2020-003350-72, retrospectively registered March 20, 2023. https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05776212.

Comparative effectiveness of buprenorphine adherence with telemedicine vs. in-person for rural and urban patients

BACKGROUND

Policy changes during the COVID-19 pandemic allowed buprenorphine to be prescribed for opioid use disorder via telemedicine without an in-person visit. A recently proposed change will limit buprenorphine access to 30 days without an in-person visit. Given that people living in rural areas may be disproportionally impacted by this change, we sought to better understand how buprenorphine adherence may be impacted by requiring in-person visits.

OBJECTIVE

Compare buprenorphine adherence after telemedicine to adherence after in-person visits for patients who live in rural and urban areas.

METHODS

In this retrospective cohort study, we used electronic health record data from a large medical center. The cohort included all adult patients prescribed buprenorphine for opioid use disorder during 2017-2022. The primary outcome was adherence, characterized by the Medication Possession Ratio (MPR) and gaps in buprenorphine treatment at 30 and 180 days. We conducted a longitudinal analysis at visit level, stratified by patient urbanicity, and controlled for patient, prescriber, prescription, and setting characteristics.

RESULTS

From 511 patients, we followed 3302 in-person and 519 telemedicine visits. Compared to in-person visits we observed no difference in the adherence following telemedicine visits overall. However, telemedicine was associated with higher MPR for rural patients (30 days: adjusted marginal effects [AME], 3.7%; 95% CI, 2.0-5.5; P < 0.001 and 180 days: AME, 8.5%; 95% CI 5.7-11.3; P < 0.001) and fewer gaps (30 days: AME, -6.7%; 95% CI, -9.9 to -0.1; P < 0.001 and 180 days: AME, -9.4%; -14.0 to -4.5; P < 0.001) compared to in-person visits.

CONCLUSION

These findings suggest that telemedicine is a viable alternative to in-person visits, especially for patients living in rural areas, which should help guide future policies that preserve or increase access to buprenorphine in a manner that can reduce barriers for patients.

Design and Staged Implementation of a Multidisciplinary Preoperative Anemia Clinic at a Tertiary Care Medical Center

BACKGROUND

Preoperative anemia is common and associated with adverse outcomes in surgical patients. There is limited information to guide the design and implementation of preoperative anemia clinics (PAC), which represents a critical barrier to entry for many practices.

METHODS

This is a descriptive observational study highlighting the design and implementation of a multidisciplinary PAC, including key steps in planning, stakeholder engagement, organizational structure, identification of target populations, establishing anemia treatments, information technology and electronic health record integration, provider training, and data infrastructure. Demographic and clinical characteristics, laboratory results, and anemia treatments for individuals evaluated in the PAC from November 4, 2019 through September 15, 2023 are enumerated. Patient-reported outcomes (PROs) assessing changes in anemia symptoms and well-being after surgery are evaluated for 2 subsets of patients (one before PAC implementation [pre-PAC], another after PAC implementation [post-PAC]), without formal statistical comparison given limited sample sizes.

RESULTS

The PAC was initiated as a multidisciplinary effort under support from a Mayo Clinic Practice Transformation Award in 2019, including broad representation from anesthesiology, surgery, and medical practices, along with institutional project management support (eg, project manager, information technologists, systems engineers). While initially limited to cardiac surgery patients, the PAC underwent planned incremental expansion to include other surgical services. Over the study period, 1188 PAC consultations across 1159 unique patients met eligibility criteria, with a median age of 66 (57-73) years and 58.1% women. The most common etiology of anemia was iron deficiency (69.1%) followed by anemia related to cancer (17.3%). Anemia-directed therapies were recommended in 1038 (87.4%) encounters, with 730 (70.3%) of those receiving recommended treatment preoperatively. Seven hundred nine (97.1%) treatments included intravenous iron and 146 (20.0%) included erythropoiesis-stimulating agents. Fifteen pre-PAC and 38 post-PAC implementation patients completed PROs. PAC implementation was accompanied by earlier resolution of anemia symptoms and less pronounced declines in postoperative well-being scores.

CONCLUSIONS

This report highlights the key steps for successful PAC implementation. Treatment is possible for most patients and may be accompanied by improvements in patient-important outcomes.

Exploration of the relationship between primary dysmenorrhea, pain perception, and menstruation-related quality of life in young women: a cross-sectional observational study

Background

This study explores the relationship between primary dysmenorrhea (PD), pain, pain catastrophizing, and menstruation-related quality of life in young women.

Methods

A cross-sectional study was conducted involving 44 young women, both with and without PD. Various variables including pain intensity, pain catastrophizing, and menstruation-related quality of life were assessed using validated questionnaires. Correlation and regression analyses were performed to examine the relationships between the variables.

Results

Significant associations were found between the presence of PD, tendency to catastrophize pain, and decreased menstruation-related quality of life. A high correlation was observed between pain intensity and catastrophizing, indicating mutual influence between these variables. Menstruation-related quality of life was affected in terms of health perception, psychological aspect, and symptoms among women with PD. The linear regression model demonstrated that catastrophizing explained 42.8% of the variance in menstruation-related quality of life.

Conclusions

These findings underscore the importance of addressing dysmenorrhea in young women, as it significantly impacts their quality of life related to menstruation. Understanding the factors contributing to dysmenorrhea and its effects on quality of life can inform more effective, patient-centered treatment strategies.

General practice utilisation by Australian cancer patients in the last year of life

OBJECTIVES

General practice plays a key role in end-of-life care, yet the extent of this remains largely unknown due to a lack of detailed clinical data. This study aims to describe the care provided by General Practitioners (GPs) for people with cancer in their last year of life.

METHODS

Retrospective cohort study using linked routine primary care and death certificate data in Victoria, Australia. Patients were included who died from cancer between 2008 and 2017.

RESULTS

In total 7025 cancer patients were included, mean age of 74.8 yrs. 95% of patients visited their GP in the last 6 months of life, with a median of 11 general practice contacts in this period. 72% of patients visited their GP in the second-last month prior to death, and 74% in the last month of life. The majority of patients (58%) were prescribed opioids, 19% anticipatory medications, 24% received a home visit, and a small proportion had imaging (6%) in the last month and pathology (6%) in the last fortnight. Patients in regional areas had more contact with general practices in the last year of life compared to metropolitan patients (median metropolitan = 16, inner regional = 25, and outer regional = 23, P < .001). The use of GP services did not differ by cancer type.

CONCLUSIONS

GP's play a central role in end-of-life care provision for cancer patients, which intensifies in the last months of life. There is room for improvement, with a proportion having little or no engagement, and low rates of home visits and anticipatory medication prescribing.

Increased behavioural inhibition and decreased behavioural activation in whiplash-associated disorders: Associations with health outcomes

BACKGROUND

Motivation can be investigated with the BIS (Behavioural Inhibition System)/BAS (Behavioural Activation System) scale. BAS regulates the motivation to approach goal-oriented outcomes, particularly rewarding stimuli and situations, while BIS regulates escape and avoidance of unpleasant outcomes. Chronic whiplash-associated disorders (WAD) is a heterogenous pain condition with known alterations in motivated behaviour. The study aimed (1) to investigate the relationship between BIS/BAS, and pain and disability with quality of life and psychological measures in chronic WAD; (2) to determine if BIS and/or BAS mediate the relationships between pain, disability, and psychological symptoms and quality of life.

METHODS

254 chronic WAD patients participated in the study. Outcome measures were assessed using self-report questionnaires. BIS/BAS scores were compared to published normative data. Differences in health outcomes for participants within/outside normative 95% confidence intervals were compared and correlations with health measures tested. Mediation models explored bi-directional associations between stress, anxiety, depression, post-traumatic stress severity, pain catastrophizing, and quality of life with pain and disability.

RESULTS

Participants who exceeded normative 95% confidence intervals for BIS demonstrated higher scores for pain interference, disability and all mental health measures. No mediating role of BIS/BAS on the relation between pain and disability with quality of life and health outcomes could be confirmed.

CONCLUSIONS

A comparatively large proportion of the sample exceeded the 95% confidence interval for BIS and BAS scores with associations of these scores with health outcomes, but altered motivation to approach goal-oriented outcomes appears to play only a subordinate role in chronic WAD.

SIGNIFICANCE STATEMENT

In line with current theories, we found a large proportion (30%-50%) of patients with whiplash-associated disorders (WAD) showing signs of altered function in the Behavioural Inhibition System (BIS) and Behavioural Activation System (BAS) suggesting altered reward processing and motivation in these patients. While such altered functions showed associations with pain interference, disability and all mental health measures, reward processing could no be demonstrated as a pathogenetically relevant factor in chronic WAD patients.

Not for everyone: Factors influencing who receives psychotherapy in people with multiple sclerosis

BACKGROUND

Although depression and anxiety are common in people with multiple sclerosis (pwMS), access to psychotherapy remains limited.

OBJECTIVES

This study aimed to identify clinical factors that predict use of psychotherapy among pwMS.

METHODS

From a retrospective chart review of a tertiary neuropsychiatry clinic in Toronto, Canada, data were obtained for 267 pwMS who received neuropsychiatric treatment (either with antidepressants or psychotherapy). Candidate predictor variables included demographics (e.g. age, sex), disease-related factors (e.g. disease duration, MS subtype, Expanded Disability Status Scale (EDSS) score), symptom data (e.g. Hospital Anxiety and Depression Scale sub-scales for anxiety and depression, five-item Modified Fatigue Impact Scale), and other treatment use (e.g. disease-modifying therapies, psychotropic medications). A backward stepwise logistic regression analysis identified predictors of psychotherapy use (p<.05).

RESULTS

Mean age was 46.97 years, 70.41 % were female, median EDSS was 2.50, 63.30 % had relapsing illness, and 22.47 % received psychotherapy. Increased EDSS scores (OR=0.74, 95 % CI 0.58-0.95, p=.02) and prolonged disease duration (OR=0.94, 95 % CI 0.89-0.99, p=.03) predicted decreased use of psychotherapy.

CONCLUSIONS

Neurological disability and disease duration may influence psychotherapy use among pwMS. Studies are now needed to evaluate contributors to these associations to expand access to non-pharmacological treatments for pwMS.

The links between parenting, self-esteem, and depressive symptoms: a meta-analysis

INTRODUCTION

Framed by attachment and cognitive theories, the current meta-analysis tested the direct and indirect links among parenting dimensions (parental support, authoritative control, psychological control, and behavioral control), self-esteem, and depressive symptoms for children and adolescents.

METHODS

Based on 53 studies, and 74 independent samples, the present study used One-Stage Meta-analytic Structural Equation Modeling (OSMASEM) to investigate these links, including testing a mediation effect by self-esteem between parental support-, authoritative control-, psychological control-, behavioral control-, and depressive symptoms. It also tested for potential moderation effects by several variables.

RESULTS

The evidence indicated that parental support (β = .29), authoritative control (β = .23), and behavioral control (β = .07) are positive correlates of self-esteem, while psychological control (β = -.26) is a negative one. It also found that self-esteem was negatively associated with depressive symptoms (β range: -.49 to -.53). Furthermore, parental support (β = -0.14), authoritative control (β = -0.10), and behavioral control (β = -0.05) are negative correlates of depressive symptoms, while psychological control is a positive correlate (β = .11). OSMASEM also provided evidence that parental support, authoritative control, psychological control, and behavioral control are indirectly associated with depressive symptoms, via self-esteem.

CONCLUSION

Parenting dimensions are associated with depressive symptoms both directly and indirectly. That is, self-esteem partially mediates the relationships between parental support, authoritative control, psychological control, and behavioral control with depressive symptoms. Furthermore, OSMASEM moderator tests provided evidence of several significant moderators, including age, sex, parenting measurement, and self-esteem measurement.

Management of Nausea and Vomiting in Palliative Care - Real Life Data From a Palliative Care Unit in Germany

BACKGROUND

Nausea and vomiting significantly impact the quality of life in palliative care. Due to various underlying causes, treatment approaches vary. However, scientific evidence on pharmacotherapeutic management is limited, complicating treatment decisions. Objective is to assess the current antiemetic treatment approach in palliative care in Germany.

METHODS

A retrospective observational study (15 months) was conducted, evaluating clinical records of adult patients admitted to palliative care in a German hospital. Symptom burden (Integrated Palliative care Outcome Scale (IPOS®)), suspected aetiology, antiemetics, treatment quality and drug-related problems (DRPs) were evaluated.

RESULTS

We included 330 patients (median age 71 years, 50.9% female), of which 172 (52%) experienced nausea/vomiting in 230 treatment episodes. Symptoms were more prevalent in cancer-patients (P = 0.002) and women (P = 0.002). Main aetiologies were intestinal obstruction (59/230, 25.7%), hypomotility (31/230, 16.1%), and raised intracranial pressure (23/230, 10.0%). Nearly 70% experienced a reduction of symptom burden within the first 3 days, with faster symptom relief and shorter episodes in cancer patients compared to non-cancer patients (median length 3d vs 2d). DRPs were documented in 213/230 episodes (92.6%), indicating high interaction potential of antiemetics (87.4%). Manifest DRPs affected patients due to ineffective treatment (29.0%) or side effects (6.5%).

CONCLUSIONS

One-third experienced inadequate symptom control with the current treatment, underscoring the complexity of managing nausea/vomiting in palliative care and the need for a systematic approach. This study emphasizes the importance of evidence-based guidelines and further research into underutilized antiemetics, along with improved medical education in an interdisciplinary team to enhance treatment quality.

Relevant determinants of Dutch patients' informed decision-making and use of online access to medical records

Patient online access to medical records can foster patient empowerment and advance patient-centered healthcare. Despite high patient interest, user rates often remain low. While previous research has identified determinants influencing the adoption of online access, this study assessed the relevance of these determinants. By doing so, this study aimed to point towards measures to improve adoption efficiently. Furthermore, supporting patient-informed decision-making about using online access might facilitate sustained use. Therefore, conducting a nationwide online survey study among Dutch adults, we examined the relevance of 22 psychological determinants for the use of online access (N = 1888) and decisional conflict (as an indicator of uninformed decision-making) regarding use (N = 3403). Analyses concerned visualization of univariate distributions of determinants and their associations with (i) use and (ii) decisional conflict regarding use. Greater relevance was indicated by lower means and stronger associations. Results showed that secured data privacy and feeling sufficiently instructed were most relevant for use. Concerning decisional conflict regarding the use, additionally, patients' beliefs about the effects of online access on their ability to participate in their healthcare process and on the patient-provider relationship were most relevant. Overall explained variance was low (R2 = 0.17 for use and R2 = 0.19 for decisional conflict). Efficiently supporting the use of online access and informed decision-making about use might be achieved by addressing data privacy, providing clear instructions and communicating potential effects. The low explained variance indicates the need for additional measures, such as facilitating easy opportunities and understanding individual patient preferences.

Anesthetic management for large vessel occlusion acute ischemic stroke with tandem lesions

BACKGROUND

Endovascular therapy (EVT) stands as an established and effective intervention for acute ischemic stroke in patients harboring tandem lesions (TLs). However, the optimal anesthetic strategy for EVT in TL patients remains unclear. This study aims to evaluate the impact of distinct anesthetic techniques on outcomes in acute ischemic stroke patients presenting with TLs.

METHODS

Patient-level data, encompassing cases from 16 diverse centers, were aggregated for individuals with anterior circulation TLs treated between January 2015 and December 2020. A stratification based on anesthetic technique was conducted to distinguish between general anesthesia (GA) and procedural sedation (PS). Multivariable logistic regression models were built to discern the association between anesthetic approach and outcomes, including the favorable functional outcome defined as 90-day modified Rankin Score (mRS) of 0-2, ordinal shift in mRS, symptomatic intracranial hemorrhage (sICH), any hemorrhage, successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) score ≥2b), excellent recanalization (mTICI 3), first pass effect (FPE), early neurological improvement (ENI), door-to-groin and recanalization times, intrahospital mortality, and 90-day mortality.

RESULTS

Among 691 patients from 16 centers, 595 patients (GA 38.7%, PS 61.3%) were included in the final analysis. There were no significant differences noted in the door-to-groin time (80 (46-117.5) mins vs 54 (21-100), P=0.607) and groin to recanalization time (59 (39.5-85.5) mins vs 54 (38-81), P=0.836) among the groups. The odds of a favorable functional outcome (36.6% vs 52.6%; adjusted OR (aOR) 0.56, 95% CI 0.38 to 0.84, P=0.005) and a favorable shift in the 90-day mRS (aOR 0.71, 95% CI 0.51 to 0.99, P=0.041) were lower in the GA group. No differences were noted for sICH (3.9% vs 4.7%, P=0.38), successful recanalization (89.1% vs 86.5%, P=0.13), excellent recanalization (48.5% vs 50.3%, P=0.462), FPE (53.6% vs 63.4%, P=0.05), ENI (38.9% vs 38.8%, P=0.138), and 90-day mortality (20.3% vs 16.3%, P=0.525). An interaction was noted for favorable functional outcome between the type of anesthesia and the baseline Alberta Stroke Program Early CT Score (ASPECTS) (P=0.033), degree of internal carotid artery (ICA) stenosis (P<0.001), and ICA stenting (P<0.001), and intraparenchymal hematoma between the type of anesthesia and intravenous thrombolysis (P=0.019). In a subgroup analysis, PS showed better functional outcomes in patients with age ≤70 years, National Institutes of Health Stroke Scale (NIHSS) score <15, and acute ICA stenting.

CONCLUSIONS

Our findings suggest that the preference for PS not only aligns with comparable procedural safety but is also associated with superior functional outcomes. These results prompt a re-evaluation of current anesthesia practices in EVT, urging clinicians to consider patient-specific characteristics when determining the optimal anesthetic strategy for this patient population.