bluuebunny/crossref_metadata_2025 huggingface dataset:
Association Between Smoking Cessation Treatment and Healthcare Costs in a Single-Payer Public Healthcare System
Authors: Baliunas Dolly , Voci Sabrina , de Oliveira Claire , Selby Peter , Kurdyak Paul , Rosella Laura , Zawertailo Laurie , Fu Longdi , Sutradhar Rinku
Published: July 2022

Introduction

There has been little investigation of whether the clinical effectiveness of smoking cessation treatments translates into differences in healthcare costs, using real-world cost data, to determine whether anticipated benefits of smoking cessation treatment are being realized.

Aims and Methods

We sought to determine the association between smoking cessation treatment and healthcare costs using linked administrative healthcare data. In total, 4752 patients who accessed a smoking cessation program in Ontario, Canada between July 2011 and December 2012 (treatment cohort) were each matched to a smoker who did not access these services (control cohort). The primary outcome was total healthcare costs in Canadian dollars, and secondary outcomes were sector-specific costs, from one year prior to the index date until December 31, 2017, or death. Costs were partitioned into four phases: pretreatment, treatment, posttreatment, and end-of-life for those who died.

Results

Among females, total healthcare costs were similar between cohorts in pretreatment and posttreatment phases, but higher for the treatment cohort during the treatment phase ($4,554 vs. $3,237, p < .001). Among males, total healthcare costs were higher in the treatment cohort during pretreatment ($3,911 vs. $2,784, p < .001), treatment ($4,533 vs. $3,105, p < .001) and posttreatment ($5,065 vs. $3,922, p = .001) phases. End-of-life costs did not differ. Healthcare sector-specific costs followed a similar pattern.

Conclusions

Five-year healthcare costs were similar between females who participated in a treatment program versus those that did not, with a transient increase during the treatment phase only. Among males, treatment was associated with persistently higher healthcare costs. Further study is needed to address the implications with respect to long-term costs.

Implications

The clinical effectiveness of pharmacological and behavioral smoking cessation treatments is well established, but whether such treatments are associated with healthcare costs, using real-world data, has received limited attention. Our findings suggest that the use of a smoking cessation treatment offered by their health system is associated with persistent higher healthcare costs among males but a transient increase among females. Given increasing access to evidence-based smoking cessation treatments is an important component in national tobacco control strategies, these data highlight the need for further exploration of the relations between smoking cessation treatment engagement and healthcare costs.
A Koshihikari X Oryza rufipogon Introgression Line with a High Capacity to Take up Nitrogen to Maintain Growth and Panicle Development under Low Nitrogen Conditions
Authors: Adu Bright G , Argete Aizelle Y S , Egawa Sakiko , Nagano Atsushi J , Shimizu Akifumi , Ohmori Yoshihiro , Fujiwara Toru
Published: July 2022

Nitrogen (N) is an important macronutrient for plant growth and development. Currently, N fertilizers are required for the efficient production of modern crops such as rice due to their limited capacity to take up N when present at low concentrations. Wild rice represents a useful genetic resource for improving crop responses to low nutrient stress. Here, we describe the isolation and characterization of an introgression line, KRIL37, that carries a small region of the Oryza rufipogon genome in the Oryza sativa L. cv Koshihikari (KH) background. This line was found to grow better under low N conditions and have similar or lower C/N ratios in aerial portions compared to those in the parental KH cultivar, suggesting that KRIL37 has a higher capacity to take up and assimilate N when present at low concentrations. KRIL37 performance in the field was also better than that of KH cultivated without N and fertilizer (−F). Transcriptome analyses of 3-week-old seedlings based on RNA-sequencing revealed that KH induced a wider suite of genes than the tolerant line KRIL37 in response to low N conditions. Some ammonium transporters and N assimilation genes were found to be induced under low N in KRIL37, but not in KH. Our findings suggest that the superior growth performance of KRIL37 under limited N conditions could be due to the expression of wild alleles influencing N uptake and assimilation. Our study demonstrates the potential to use wild rice genomes to improve modern crops for low nutrient tolerance.
Natural alleles of the abscisic acid catabolism geneZmAbh4modulate water use efficiency and carbon isotope discrimination in maize
Authors: Blankenagel Sonja , Eggels Stella , Frey Monika , Grill Erwin , Bauer Eva , Dawid Corinna , Fernie Alisdair R , Haberer Georg , Hammerl Richard , Barbosa Medeiros David , Ouzunova Milena , Presterl Thomas , Ruß Victoria , Schäufele Rudi , Schlüter Urte , Tardieu Francois , Urbany Claude , Urzinger Sebastian , Weber Andreas P M , Schön Chris-Carolin , Avramova Viktoriya
Published: July 2022

Altering plant water use efficiency (WUE) is a promising approach for achieving sustainable crop production in changing climate scenarios. Here, we show that WUE can be tuned by alleles of a single gene discovered in elite maize (Zea mays) breeding material. Genetic dissection of a genomic region affecting WUE led to the identification of the gene ZmAbh4 as causative for the effect. CRISPR/Cas9-mediated ZmAbh4 inactivation increased WUE without growth reductions in well-watered conditions. ZmAbh4 encodes an enzyme that hydroxylates the phytohormone abscisic acid (ABA) and initiates its catabolism. Stomatal conductance is regulated by ABA and emerged as a major link between variation in WUE and discrimination against the heavy carbon isotope (Δ13C) during photosynthesis in the C4 crop maize. Changes in Δ13C persisted in kernel material, which offers an easy-to-screen proxy for WUE. Our results establish a direct physiological and genetic link between WUE and Δ13C through a single gene with potential applications in maize breeding.
Knowing receipt: the ‘continuing proprietary interest’
Authors: Roxburgh Alan
Published: July 2022

The principal question for the Court of Appeal in Byers v The Saudi National Bank was whether a claim in knowing receipt can succeed against a defendant who has received assets transferred in breach of trust, even though the effect of the transfer to the defendant was to extinguish or override the beneficiary’s equitable proprietary interest. The judgment also considers the proper approach of an appellate court to a trial judge’s findings on issues of foreign law.
PATHMAP (Pathogen And Tree fruit Health MAP): A Smartphone App and Interactive Dashboard to Record and Map Tree Fruit Diseases, Disorders, and Insect Pests
Authors: Jurick Wayne M. , Messinger Lindsey , Wallis Anna , Peter Kari A. , Villani Sara , Bradshaw Michael J. , Bartholomew Holly P. , Buser Michael , Aćimović Srđan G. , Fonseca Jorge M. , Cox Kerik D.
Published: July 2022

PATHMAP (Pathogen And Tree fruit Health MAP) is a smartphone application (app) and interactive dashboard developed specifically for support specialists, extension personnel, and university scientists supporting the tree fruit industry. The PATHMAP app collects detailed information about observed diseases, insect pests, and disorders and provides the option to attach photos. The data are then visualized using a graphical interface dashboard displaying an interactive color-coded map. Prior to the development of PATHMAP, abundant tree fruit disorder data were collected each year, but a central interactive repository for archiving data and facilitating communication of field observations did not exist. PATHMAP has been beta tested by university extension personnel, private consultants, and university scientists to ensure usability and functionality. PATHMAP will be used within the tree fruit industry for monitoring known pest patterns, occurrences, and outbreaks of emerging pathogens. It will augment existing extension diagnosis listservs that have value in visual diagnosis but are cumbersome and have no archiving capabilities. Data obtained through the tool can be used in epidemiological meta-analyses and to develop new predictive models, and can serve as a platform to track emerging pathogens, insects, and disorders for a variety of cropping systems.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2022.
Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience
Authors: Bann Maralyssa , Larimore Savannah , Wheeler Jessica , Olsen Lauren D.
Published: July 2022

Purpose

Following shifts that broadened the medical profession’s conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.

Method

In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.

Results

Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.

Conclusions

Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.
Facilitating Integrated Perinatal Care for Families Affected by Substance Use
Authors: Schmidt Christina N. , Patel Devika , Alpers Benjamin S. , Spaulding Marcy , Ocegueda Liliana , Thomas Melanie , Sammann Amanda , Briscoe Heather
Published: July 2022

Families of newborns are frequently referred to child protection systems because of parental substance use, yet many families face barriers to accessing prenatal care and substance use treatment services. Although federal legislation requires states to develop Plans of Safe Care to address families' health and substance use treatment needs, few have developed comprehensive and systematic approaches to provide perinatal support to parents and infants. In this commentary, we describe the development and initial testing of a Plan of Safe Care that engages patients and their providers in perinatal care coordination. Developed out of an in-depth analysis of current care workflows at an urban safety net health system, the Plan of Safe Care facilitates conversations with clients around delivery planning and aligns resources to support families with substance use disorders.
Conversion total hip arthroplasty after previous intertrochanteric hip fractures: a review of the epidemiology, technical issues, and outcomes
Authors: Rinehart Dustin B. , Fene Evan S. , Huo Michael H.
Published: July 2022

Conversion total hip arthroplasty (THA) after previous intertrochanteric (IT) hip fracture is a unique operation that is different from the routine primary total hip arthroplasty (THA) done for osteoarthritis or femoral head necrosis. Conversion THAs are similar to revision THAs with regard to complexity, technical challenges, implant costs, and perioperative complications. A literature review was performed with specific focus on the surgical techniques, patient outcomes, and financial burdens of conversion THAs after IT fracture treatment with either a sliding compression hip screw with side plate (SSP), or a cephalomedullary nail (CMN). The reported data demonstrated similar technical challenges regardless of the method of the index treatment of the IT fracture. The surgeon must plan and be prepared for more difficult and extensile exposure, available instruments for the hardware removal, altered proximal femoral geometry, and available implant inventory for the reconstruction. The outcomes are consistent with higher rates of instability and infection in the conversion THAs compared with primary THAs. There is no significant difference in the clinical outcomes of conversion THAs following either SSP or CMN. Overall, conversion THAs pose greater technical challenges. The clinical outcomes of conversion THAs remain inferior to the primary THAs. The complications and patient functional outcomes are similar to those following revision THAs.
Patient-Reported Outcome Measurement Information System (PROMIS) Scores in Pediatric Idiopathic Toe Walkers
Authors: Lindsay Sarah E. , Bauer Jeremy , Bouton Daniel , Do Patrick , Woodmark Carly , Sienko Susan , Raney Ellen M.
Published: July 2022

Background:

Idiopathic toe walking (ITW) can result in early contact with the health care system and be distressing for patients and their families. The natural history of ITW is poorly characterized. Deciding how and when to intervene can be difficult.

Patient-reported outcomes are utilized in the clinical setting to assess patient factors and indications that may better inform treatment plans. Patient-Reported Outcomes Measurement Information System (PROMIS) is an instrument designed to collect patient-reported outcomes. Minimum clinically important differences in PROMIS metrics have been established to facilitate clinical relevance and utility of these metrics. The purpose of this study was to characterize the patient perspective of ITW by utilizing the PROMIS scores.

Methods:

Retrospective chart review was performed to identify children aged 5 to 17 with a diagnosis of ITW treated at a single tertiary care center between 2017 and 2020. Inclusion criteria were a diagnosis of ITW and completion of a PROMIS questionnaire. Exclusion criteria were neurologic disease, autism, and previous surgical treatment. Demographic, physical exam, treatment, and available motion analysis data were collected. PROMIS scores for the following domains were available: Mobility, Peer Relationships, and Pain Interference.

Results:

Forty-five children were enrolled. Seventy-three percent of PROMIS scores were patient reported while the remainder were parent reported. PROMIS score means for the cohort by domain were Mobility: 45.2±8.2 (P<0.000); Peer Relationships: 46.4±11.6 (P=0.047); and Pain Interference: 47.4±9.5 (P=0.67). Motion analysis data, available for 11 children, noted age-matched gait velocity negatively correlated (r
s=−0.652, P=0.03) with Peer Relationships. No correlations were found between other aspects of gait, body mass index, or limitations in dorsiflexion and PROMIS domains. Parents reported lower Mobility scores than children did. There were no other significant differences between patient-reported and parent-reported PROMIS scores. PROMIS scores did not differ significantly between those <10 years and those ≥10 years.

Conclusion:

In this cohort of 45 otherwise healthy children without other neurologic diagnoses, there are both clinically and statistically significant differences in PROMIS means between our cohort and the healthy age-matched population. These differences manifested in worse peer relationships and mobility scores.

Level of Evidence:

Level IV.
Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion
Authors: Karamian Brian A. , Mao Jennifer , Toci Gregory R. , Lambrechts Mark J. , Canseco Jose A. , Qureshi Mahir A. , Silveri Olivia , Minetos Paul D. , Jallo Jack I. , Prasad Srinivas , Heller Joshua E. , Sharan Ashwini D. , Harrop James S. , Woods Barrett I. , Kaye Ian David , Hilibrand Alan , Kepler Christopher K. , Vaccaro Alexander R. , Schroeder Gregory D.
Published: July 2022

Study Design.

Retrospective case-control study.

Objective.

To compare health-related quality of life outcomes at one-year follow-up between patients who did and did not develop surgical site infection (SSI) after thoracolumbar spinal fusion.

Summary of Background Data.

SSI is among the most common healthcare-associated complications. As healthcare systems increasingly emphasize the value of delivered care, there is an increased need to understand the clinical impact of SSIs.

Materials and Methods.

A retrospective 3:1 (control:SSI) propensity-matched case-control study was conducted for adult patients who underwent thoracolumbar fusion from March 2014 to January 2020 at a single academic institution. Exclusion criteria included less than 18 years of age, incomplete preoperative and one-year postoperative patient-reported outcome measures, and revision surgery. Continuous and categorical data were compared via independent t tests and χ2 tests, respectively. Intragroup analysis was performed using paired t tests. Regression analysis for ∆ patient-reported outcome measures (postoperative minus preoperative scores) controlled for demographics. The α was set at 0.05.

Results.

A total of 140 patients (105 control, 35 SSI) were included in final analysis. The infections group had a higher rate of readmission (100% vs. 0.95%, P<0.001) and revision surgery (28.6% vs. 12.4%, P=0.048). Both groups improved significantly in Physical Component Score (control: P=0.013, SSI: P=0.039), Oswestry Disability Index (control: P<0.001, SSI: P=0.001), Visual Analog Scale (VAS) Back (both, P<0.001), and VAS Leg (control: P<0.001, SSI: P=0.030). Only the control group improved in Mental Component Score (P<0.001 vs. SSI: P=0.228), but history of a SSI did not affect one-year improvement in ∆MCS-12 (P=0.455) on regression analysis. VAS Leg improved significantly less in the infection group (−1.87 vs. −3.59, P=0.039), which was not significant after regression analysis (β=1.75, P=0.050).

Conclusion.

Development of SSI after thoracolumbar fusion resulted in increased revision rates but did not influence patient improvement in one-year pain, functional disability, or physical and mental health status.
A typical bedside-to-bench investigation of leukemogenic driver MEF2D fusion reveals new targeted therapy in B-cell acute lymphoblastic leukemia
Authors: Zhang Hao , Meng Guoyu
Published: July 2022

B-cell acute lymphoblastic leukemia (B-ALL) is a malignant tumor originating from B-lineage lymphoid precursor cells. The incidence of B-ALL is about 80% in childhood acute leukemia and 20% in adults. In recent years, with standardized treatment guided by risk stratification, the long-term disease-free survival rate of children is about 80%, while that of adults is less than 40%. However, the specific pathogenesis of the newly identified B-ALL and the targeted therapy strategies have not been vigorously investigated. In this review, we highlight the recent breakthroughs in mechanistic studies and novel therapeutic options in DUX4- and MEF2D-subtype B-ALLs.
Discharge readiness after remimazolam versus propofol for colonoscopy
Authors: Yao Yusheng , Guan Jinsheng , Liu Linwei , Fu Bingbing , Chen Lei , Zheng Xiaochun
Published: July 2022

BACKGROUND

Remimazolam is an ultrashort-acting benzodiazepine that is potentially a practical option for procedural sedation in colonoscopy.

OBJECTIVE

To test the hypothesis that remimazolam could provide a noninferior discharge time to propofol for ambulatory colonoscopy.

DESIGN

A prospective, randomised, double-blind, noninferiority clinical trial.

SETTING

Ambulatory endoscopy centre.

PATIENTS

A total of 132 adult participants undergoing ambulatory colonoscopy were enrolled.

INTERVENTIONS

Participants were randomly assigned in a 1 : 1 ratio to receive propofol or remimazolam for sedation.

MAIN OUTCOME MEASURES

The primary outcome was discharge time after a colonoscopy, assessed using the Modified Postanaesthetic Discharge Scoring System scale. Secondary outcomes included induction time, emergence time, the extent of recovery upon arrival in the postanaethesia care unit, fatigue, endoscopist and patient satisfaction and adverse events.

RESULTS

The median discharge time was 24 min in the remimazolam group versus 21 min in the propofol group, with a difference of 2 min [95% confidence interval (CI), 0 to 4 min], meeting the criteria for noninferiority. Injection pain occurred in 11 of 66 (17%) participants receiving remimazolam versus 32 of 66 (49%) participants receiving propofol (P < 0.001); hypotension occurrence was 20% versus 47%, (P < 0.001), respectively, and bradycardia 6% versus 20%, (P = 0.019), respectively. Compared with propofol, the patient satisfaction score was higher in the remimazolam group (P < 0.001).

CONCLUSION

For sedation in ambulatory colonoscopy, compared with propofol, remimazolam provides a noninferior discharge time. Furthermore, remimazolam is associated with less injection pain, lower risks of hypotension and bradycardia, and improved patient satisfaction.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, identifier: ChiCTR2100048678.
Biochemical Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors by Cardiovascular Risk Profile and Volume Status in a Real-World Diabetic Population
Authors: Gitto Mauro , Kotinas Alexios S. , Terzi Riccardo , Oliva Angelo , Zagoreo Jorgele , Reimers Bernhard , Stefanini Giulio G. , Mirani Marco , Favacchio Giuseppe , Condorelli Gianluigi , Panico Cristina
Published: July 2022

Despite large-scale randomized clinical trials (RCTs) highlighting a consistent prognostic benefit of sodium–glucose cotransporter 2 inhibitors (SGLT2is) both in diabetic patients at high cardiovascular risk and in those with heart failure, there is relative paucity of data on their biochemical effects in a real-world setting. We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral center and completed at least 1 year of treatment. Changes in glycated hemoglobin, weight, and hematocrit were compared across 2 cardiovascular risk categories, defined through the inclusion criteria of 3 large RCTs. Of the 459 patients screened, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%), and 55 were lost to follow-up (12.0%). The most common cause of drug discontinuation was genital or urinary tract infections (9.4%). At 1 year, reduction in glycated hemoglobin concentration (−0.7 ± 1.5%, P < 0.001) and body weight (2.4 ± 4.6 kg, P < 0.001) was comparable between patients at high versus low cardiovascular risk, while hematocrit increase (2.3 ± 3.3%, P < 0.001) was more marked in patients with high cardiovascular risk and low baseline hematocrit. In a real-world population of diabetic patients, SGLT2is were well-tolerated at 1 year and led to improved glycemic control and weight loss. Hematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating euvolemic restoration as a potential cardioprotective mechanism mediated by these compounds.
Modulation of Mitochondrial Respiration During Early Reperfusion Reduces Cardiac Injury in Donation After Circulatory Death Hearts
Authors: Akande Oluwatoyin , Chen Qun , Cholyway Renee , Toldo Stefano , Lesnefsky Edward J. , Quader Mohammed
Published: July 2022

Donation after circulatory death (DCD) donors are a potential source for heart transplantation. The DCD process has unavoidable ischemia and reperfusion (I/R) injury, primarily mediated through mitochondria, which limits routine utilization of hearts for transplantation. Amobarbital (AMO), a transient inhibitor of the electron transport chain, is known to decrease cardiac injury following ex vivo I/R. We studied whether AMO treatment during reperfusion can decrease injury in DCD hearts. Sprague Dawley rat hearts subjected to 25 minutes of in vivo ischemia (DCD hearts), or control beating donor hearts, were treated with AMO or vehicle for the first 5 minutes of reperfusion, followed by Krebs–Henseleit buffer reperfusion for 55 minutes (for mitochondrial isolation) or 85 minutes (for infarct size determination). Compared with vehicle, AMO treatment led to decreased infarct size (25.2% ± 1.5% vs. 31.5% ± 1.5%; P ≤ 0.05) and troponin I release (4.5 ± 0.05 ng/mL vs. 9.3 ± 0.24 ng/mL, P ≤ 0.05). AMO treatment decreased H2O2 generation with glutamate as complex I substrate in both subsarcolemmal mitochondria (SSM) (37 ± 3.7 pmol·mg−1·min−1 vs. 56.9 ± 4.1 pmol·mg−1·min−1; P ≤ 0.05), and interfibrillar mitochondria (IFM) (31.8 ± 2.8 pmol·mg−1·min−1 vs. 46 ± 4.8 pmol·mg−1·min−1; P ≤ 0.05) and improved calcium retention capacity in SSM (360 ±17.2 nmol/mg vs. 277 ± 13 nmol/mg; P ≤ 0.05), and IFM (483 ± 20 nmol/mg vs. 377± 19 nmol/mg; P ≤ 0.05) compared with vehicle treatment. SSM and IFM retained more cytochrome c with AMO treatment compared with vehicle. In conclusion, brief inhibition of mitochondrial respiration during reperfusion using amobarbital is a promising approach to decrease injury in DCD hearts.
Association of plant-based diet and early onset of natural menopause
Authors: Grisotto Giorgia , Langton Christine R. , Li Yanping , Bertone-Johnson Elizabeth R. , Baden Megu Y. , Franco Oscar H. , Hu Frank B. , Muka Taulant , Eliassen A. Heather
Published: July 2022

Objective

To evaluate the association of plant-based diet index (PDI) with early onset of natural menopause in the Nurses’ Health Study (NHS) and Nurses’ Health Study II (NHSII).

Methods

We conducted a prospective study with a mean follow-up time of 20 years among premenopausal women living across the US. Participants of the NHS (n = 121,701) and NHSII (n = 116,429) were included from 1984 (age mean [standard deviation]; 44.9 [4.3]) and 1991 (age mean [standard deviation]; 36.4 [4.6]), respectively. Early menopause was self-reported and defined as natural menopause before age 45 years. PDI was derived from semiquantitative food frequency questionnaires administered every 4 years. Cox proportional hazards models were used to assess the association between PDI in quintiles and early menopause in NHS and NHSII separately, and fixed-effect models to pool the results from both cohorts.

Results

During follow-up, 715 and 2,185 women experienced early natural menopause in NHS and NHSII, respectively. After adjustment for potential confounders, no association was observed between PDI and incidence of early natural menopause in either cohort, or when pooling the results from both cohorts, with an exception for unhealthy plant-based diet index which was associated with higher risk of early menopause with increasing levels of consumption (P trend = 0.04).

Conclusion

Adherence to PDI was not associated with timing of menopause while unhealthy plant-based diet might be associated with higher risk of experiencing early menopause.
Risk of high depressive symptoms after the final menstrual period: the Study of Women’s Health Across the Nation (SWAN)
Authors: Kravitz Howard M. , Colvin Alicia B. , Avis Nancy E. , Joffe Hadine , Chen Yuqing , Bromberger Joyce T.
Published: July 2022

Objective

To examine depressive symptoms during postmenopause and the contribution of depressive symptom trajectories before the final menstrual period (FMP) and psychosocial/health factors to postmenopause depressive symptoms.

Methods

Longitudinal analysis of depressive symptoms (Center for Epidemiologic Studies-Depression scale) collected every 1 to 2 years from 1996 to 2017 from 1,551 midlife women in the Study of Women’s Health Across the Nation for a median follow-up of 19.0 years. Latent class growth analysis identified depression trajectories from baseline to FMP. Multivariable random effects (woman as random effect) linear or logistic regression models were conducted.

Results

Women had higher odds of reporting high depressive symptom score (≥16) during postmenopause than when they were premenopausal (OR = 1.49, 95% CI, 1.09-2.04), but not when perimenopausal. Three pre-FMP trajectories were identified: Group 1 (47.7%), consistently low scores, Group 2 (39.9%), moderate scores below the high depressive symptom threshold, and Group 3 (12.4%), consistently high scores. Both the moderate (OR = 2.62, 95% CI, 1.89-3.66) and high score (OR = 6.88, 95% CI, 4.72-10.02) groups, compared with the consistently low group, had significantly higher postmenopausal depressive symptom scores. Other pre-FMP variables associated with high postmenopausal depressive symptoms were: higher odds of childhood trauma/maltreatment, poor role physical, high anxiety symptoms, sleep problems, high vasomotor symptoms, and lower odds for chronological aging and lower social support.

Conclusions

Compared with premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms. Pre-FMP depressive symptom trajectories are highly predictive of postmenopause depressive symptoms independent of health and psychosocial factors.
Meta-Analysis of Antidepressant Pharmacotherapy in Patients Eligible for Cardiac Rehabilitation
Authors: Hughes Joel W. , Kuhn Tyler A. , Ede David , Gathright Emily C. , Josephson Richard A.
Published: July 2022

Purpose:

Many patients exhibit clinically significant depression upon enrollment in cardiac rehabilitation (CR). Antidepressants are a first-line treatment option for depression, but the effectiveness of antidepressants in patients with heart disease is mixed. The purpose of this meta-analysis was to evaluate the efficacy of antidepressants for depression in patients eligible for CR.

Methods:

A meta-analysis was conducted including randomized controlled trials of antidepressants from January 1990 to September 2021 that compared antidepressants with placebo. Random-effects models were used between group effect sizes (Hedges' g).

Results:

A total of 13 trials with predominately White (68% ± 12; n =7) male (70% ± 11) samples averaging 61 ± 5 yr compared antidepressants (1128 participants) with placebo (1079 participants). Antidepressants reduced depressive symptoms (g = 0.17: 95% CI, 0.08-0.27), but the effect was small. Heterogeneity among study effects was low (I
2 = 6.42) and nonsignificant (Q = 10.75, P = .46), although patients with heart failure (g
HF = 0.05: 95% CI, -0.09 to 0.18) demonstrated smaller effects compared with patients with other cardiovascular disease conditions (gnon-HF = 0.22: 95% CI, 0.11-0.32) (Q
B [1] = 3.97; P < .05). No study reported safety concerns associated with antidepressants.

The effect size of antidepressant pharmacotherapy in this population is small. No trials reported on the combined effects of exercise and pharmacotherapy. If the patient is not suicidal, CR staff may consider patient preference and refer patients for additional treatment as necessary.
SCLERAL SUTURE FIXATION FOR DISLOCATED SILICONE PLATE HAPTIC INTRAOCULAR LENS
Authors: Smiddy William E.
Published: July 2022

Purpose:

To describe results in two cases of a dislocated silicone plate haptic intraocular lens managed with vitrectomy and repositioning with scleral suture fixation.

Methods:

Small case series.

Results:

Two patients presenting with dislocated silicone plate haptic intraocular lens underwent a 23-gauge vitrectomy with a “handshake” maneuver to pass a 9-0 prolene suture through the positioning holes to allow scleral fixation. Best-corrected visual acuity was returned to predislocation Level 2 and 8 months after the vitrectomy.

Conclusion:

Silicone plate haptic intraocular lens can be managed with scleral suture fixation using this adapted technique, avoiding removal and exchange techniques. These are the first reported cases of silicone plate haptic intraocular lens managed with scleral suture repositioning.
Preliminary Evaluation of a Novel Point of Care Diagnostic Device for Sports-Related Concussion
Authors: Wu Yueming , Abner Erin L. , Conley Caitlin , Smoot M. Kyle , Hosey Robert , Kaiser Kim , Lovell Mark A.
Published: July 2022

Objective:

Visinin-like protein 1 (VILIP-1) is a neuron-specific calcium sensor protein rapidly released into blood after mild traumatic brain injury (mTBI) and may be a suitable biomarker for identification of sports-related concussion (SRC). The objective of the study is to test if quantification of a specific post-translationally modified (ubiquitinated) form of VILIP-1 (ubVILIP-1) from a fingerstick blood sample using a point of care (POC) lateral flow device (LFD) can be used to rapidly identify athletes with SRC.

Design:

Prospective cohort study.

Setting:

Side-line blood collection at football, soccer, and volleyball games/practices.

Participants:

Division I athletes with/without SRC.

Main Outcome Measures:

Blood ubVILIP-1 concentrations.

Results:

Data collected over 2 athletic seasons from non-SRC athletes (controls) show a small but statistically significant elevation of ubVILIP-1 over an individual season for male athletes (P = 0.02) dependent on sport (P = 0.014) and no significant changes in ubVILIP-1 levels between seasons. For SRC athletes, the data show ubVILIP-1 levels substantially increase above baseline as soon as 30 minutes postdiagnosis with peak concentrations and times postinjury that vary based on injury severity.

Conclusion:

Results of the study suggest quantification of blood ubVILIP-1 levels measured using an LFD may provide an objective identification of athletes with SRC, setting the stage for further study with a larger number of SRC patients.
Zoomers: videoconferencing, appearance concerns, and potential effects on adolescents
Authors: Hart Laura M. , Mitchison Deborah , Fardouly Jasmine , Krug Isabel
Published: July 2022

Purpose of review

The cessation of in-person teaching to reduce the spread of COVID-19 dramatically increased the use of videoconferencing for home learning among adolescents.

Recent findings

A consistent finding across studies assessing the relationship between videoconferencing and appearance concerns was that time spent focused on self-view was related to greater appearance concerns. Videoconferencing was associated with an increase in desire for cosmetic surgery and other nonsurgical treatments. Among those at risk of eating disorders, videoconferencing was associated with more appearance-management behaviours and less engagement in the video call. Research to date has been correlational and predominantly involved White, adult women in the USA and in Australia, leaving important gaps in our knowledge, especially around impacts on adolescents.

Given their vulnerability to appearance concerns, we encourage practitioners to speak to adolescents about their use of videoconferencing and how they can migitate the potential negative impacts on body image.
How primary care providers can help prevent food allergies
Authors: Conroy Ellen , Ponda Punita
Published: July 2022

Purpose of review

IgE-mediated food allergy rates have increased in recent decades, yet treatment options remain limited. Prevention strategies are thus essential. We will review recent research and consensus guidelines for food allergy prevention.

Recent findings

Research has continued to support that early introduction of allergens via the gastrointestinal tract induces tolerance and prevents development of food allergy. In contrast, allergen sensitization may occur via transcutaneous allergen exposure. This is supported by research that shows a decreased risk of food allergy with aggressive treatment of atopic dermatitis. More recent research suggests that transcutaneous sensitization could also be facilitated by frequent emollient use in the absence of atopic dermatitis but definitive research is lacking. Murine models have shown a likely role of dysbiosis, or disruption of the body's normal healthy microbiome, in development of food allergy, yet human studies have yet to show a conclusive benefit of probiotics in the prevention of food allergy.

Important approaches for food allergy prevention are: introduction of peanut and cooked egg at 4–6 months, early introduction of other allergenic foods, and early diagnosis and treatment of atopic dermatitis (because of a predisposition to food sensitization through the damaged skin barrier). More research is needed to clarify the role, if any, of emollient use and probiotics.
Pearls and updates: cutaneous signs of systemic malignancy
Authors: Paquette Gabriella M. , Cotter Chantal , Huang Jennifer T.
Published: July 2022

Purpose of review

Children with systemic malignancies can present with concomitant dermatological manifestations. Cutaneous findings can occur before, during or after diagnosis. Recognizing these features can aid in diagnosis, inform prognosis, and help determine appropriate treatment. Following a review of the literature published over the past two years, we provide an update on cutaneous signs of pediatric systemic malignancies, concentrating on; leukemia cutis, lymphoma cutis, neuroblastoma, sarcomas, Langerhans cell histiocytosis and paraneoplastic syndromes.

Recent findings

Authors highlight the persistently heterogeneous features of cutaneous manifestations of systemic malignancy. Findings are often nonspecific, and a definitive diagnosis requires skin biopsy with immunophenotyping. Several studies describe dermoscopy features, demonstrating this as a useful tool in clinical evaluation. Genetic mutations underlying the pathogenesis of disease continue to be elucidated. Further, advances in medical treatment led to improved prognosis in many systemic malignancies, with early and aggressive treatment heralding better outcomes.

Comprehensive cutaneous evaluation alongside thorough clinical history and review of systems remains of paramount importance as dermatological manifestations of systemic malignancy are notoriously variable with a shared feature of often appearing benign but persisting despite usual treatment. Urgent referral to dermatology is recommended when suspicion for any cutaneous presentation of malignancy arises.
The Role of Depressive Disorders in Autonomic Cardiovascular Dysregulation in Fibromyalgia
Authors: Reyes del Paso Gustavo A. , Contreras-Merino Ana M. , Duschek Stefan
Published: July 2022

Objective

Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia.

Methods

Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression (n = 27), in participants with fibromyalgia without depression (n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance.

Results

Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls (p values < .012, d values = 0.71–1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls (p values < .013, d values = 0.62–0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls.

Conclusions

The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia.
Associations of Modifiable Behavioral Risk Factor Combinations at 65 to 74 Years Old With Cognitive Health Span for 20 Years
Authors: Smagula Stephen F. , Biggs Mary L. , Jacob Mini E. , Rawlings Andreea M. , Odden Michelle C. , Arnold Alice , Newman Anne B. , Buysse Daniel J.
Published: July 2022

Objective

Behavioral risk factors for dementia tend to co-occur and interrelate, especially poor diet, physical inactivity, sleep disturbances, and depression. Having multiple of these modifiable behavioral risk factors (MBRFs) may predict a particularly shortened cognitive health span and therefore may signal high-risk status/high intervention need.

Methods

These secondary analyses of data from the Cardiovascular Health Study included 3149 participants aged 65 to 74 years (mean [standard deviation {SD}] age = 69.5 [2.5] years; 59.6% female). MBRF exposures were self-reports regarding a) diet, b) activity, c) sleep, and d) depression symptoms. We primarily analyzed MBRF counts. For up to 26 years of follow-up, we assessed the a) number of remaining cognitively healthy life-years (CHLYs) and b) percentage of remaining life-years (LYs) that were CHLYs (%CHLY). We estimated CHLYs as time before a dementia diagnosis, cognitive screener scores indicating impairment, proxy report indicating significant cognitive decline, or dementia medication use.

Results

Participants averaged a remaining 16 LYs (SD = 7 LYs), 12.2 CHLYs (SD = 6.6 CHLYs), and 78.1% of LYs being CHLYs (SD = 25.6 CHLYs). Compared with having no MBRFs, having one was associated with ~1 less LY and CHLY, but not a relatively lower %CHLY. In contrast, having 3+ MBRFs was associated with about 2 to 3 fewer LYs and CHLYs as well as about 6% lower %CHLY (95% confidence interval = −9.0 to −2.5 %CHLYs; p = .001).

Conclusions

MBRF-related reductions in the cognitive health span are most apparent when people have multiple MBRFs. Future research is needed to determine if/how behavioral risks converge mechanistically and if dementia prevention efficacy improves when targeting MBRF combinations.
Challenges to the Implementation of the World Health Organization's International Classification for Patient Safety in Slovenia
Authors: Zupančič Vesna , Breuerbach Larsen Torsten
Published: July 2022

Background and Objectives:

Slovenia lags behind international recommendations for reporting and learning from patient safety incidents and risk management in health care. To counter this, the country established the SenSys project, which receives technical support from the European Commission's Structural Reform Support Service, in cooperation with the Danish Patient Safety Authority, and pertains to an initiative to improve health care. A subproject of the SenSys project works to adapt and implement the International Classification for Patient Safety of the World Health Organization (ICPS-WHO). This article presents a case study of the national research process to identify the necessary Slovenian national adaptation and upgrade of the ICPS-WHO, the ICPS-SL, particularly regarding types of patient safety incidents. Our aim was to reflect on how we used the insights from different research elements and learned from different aspects of our project/system development.

Methods:

We used the SQUIRE 2.0 (Standards of Quality Improvement Reporting Excellence) to present our case study. The methods used to collect information on the necessary adaptations to establish an optimal ICPS-SL included a literature review, qualitative analysis of national consultation meetings, and a 2-cycle Delphi study. This process took place between January 2018 and August 2019, and we found 18 useful articles. Participants such as providers, users, and national bodies from national consultation meetings were all key stakeholders.

Results:

The relevant stakeholders agreed upon changes to the ICPS-WHO to implement in the ICPS-SL as an integrated part of a Slovenia's incident reporting and learning system. Notably, they implemented changes in terminology in the translation of some English terms. They also added or hierarchically reordered some patient safety incident types: for example, they added the nation-specific point “treatment of pain” as a type of patient safety incident. The stakeholders will also partially integrate the following indicators: monitoring systems, vigilance systems, and complaint systems.

Conclusion:

Different research elements contributed to the ICPS-SL's new knowledge and more reliable development. We emphasized a cooperative process with a consensus-building approach while linking the knowledge, experience, and needs of various stakeholders. All interested parties adopted this process, aiming to establish conditions for national learning from patient safety incidents and better preventive action for health care quality and safety. Vertical and horizontal multidisciplinary teamwork was a focal point as well. Technical assistance proved especially useful. It is now necessary to clinically test the ICPS-SL classification framework as Slovenia's internationally harmonized standard, and have the Health Council adopt it for use both online and in practice.