Jacobs Institute of Women's Health
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Systematic review and meta-analysis of efficacy of helmet use and helmet laws to reduce mortality and cervical spine injury in adult motorcycle riders: A practice management guideline from the Eastern Association for the Surgery of Trauma
No full textBACKGROUND: Motorcycle crash fatalities remain a significant public health concern. Traumatic brain injury is a leading cause of death following motorcycle crash. We aim to provide evidence-based guidelines pertaining to helmet use and helmet laws with respect to important outcomes including mortality, cervical spine injury, and discharge disposition. METHODS: An evidence-based systematic review was performed to answer the following Population, Intervention, Comparator, Outcomes (PICO) questions: PICO 1-Should adult motorcycle riders wear helmets or not wear helmets to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? PICO 2-Should motorcycle universal helmet laws (UHLs) or no UHLs be enacted to improve mortality, brain injury-related mortality, cervical spine injury, and discharge disposition from the hospital? An academic medical librarian searched Medline, Cochrane CENTRAL, CINAHL, Embase, Engineering Village, Health and Safety Science Abstracts, Scopus, SPORTDiscus, TRID, the VHL Regional Portal, and Elsevier. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used to assess the quality of the evidence and create recommendations. The working group reached consensus on the final evidence-based recommendations. The study was registered in PROSPERO (CRD42020172705). RESULTS: A total of 28 studies were identified for analysis for PICO 1, and 10 studies were identified for PICO 2. Helmet use was associated with a lower incidence of mortality (odds ratio, 0.48; 95% confidence interval, 0.41-0.56; p \u3c 0.001) and lower incidence of cervical spine injury (odds ratio, 0.66; 95% confidence interval, 0.58-0.76; p \u3c 0.001). Although a meta-analysis for PICO 2 was not possible because of significant methodological heterogeneity, the vast majority of studies demonstrated large improvements in outcomes with a UHL. Overall certainty of evidence was deemed low for PICO 1 and PICO 2 because of risk of bias. CONCLUSION: We strongly recommend that individual motorcycle riders wear helmets and that universal helmet legislation be enacted and enforced to decrease mortality, to decrease the incidence of cervical spine injury, and to improve discharge disposition from the hospital. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level II
Cannabis use & food insecurity risk among U.S. adults with & without children
No full textINTRODUCTION: The prevalence of cannabis use and food insecurity (FI) have increased in the United States, yet how cannabis use and FI interact, particularly among young parents, remains understudied. This study assessed associations between cannabis use and FI among young adults and differences based on parental status. METHODS: The study analyzed two waves (W1-W2) of survey data from 2023-2024 among 3437 US young adults (ages 18-34; M=26.4, 61.6% female, 30.4% parents, 27.5% sexual minority, 12.5% Black). Logistic regressions examined W1 past-month cannabis use and W2 past-year FI, and W2 FI and W2 past-month cannabis use, cannabis expenditures, and impact of cannabis cost on amount used, separately, adjusting for sociodemographics and state non-medical cannabis laws. The moderating effect of parental status on each of the above associations was assessed. RESULTS: At W1, 46.6% of participants reported cannabis use. At W2, 39.5% reported cannabis use, 48.2% FI, and 22.9% cannabis use and FI. W1 cannabis use was associated with greater odds of W2 FI (adjusted odds ratio [aOR]=1.62, 95%CI=1.39, 1.88). W2 FI was associated with greater odds of W2 cannabis use (aOR=1.44, 95%CI=1.24, 1.68), greater cannabis expenditures (aOR=1.44, 95%CI=1.17, 1.78), and greater impact of cannabis cost on use (aOR=1.92, 95%CI=1.57, 2.35). The associations between W2 FI and W2 cannabis use were stronger among parents compared to adults without children. CONCLUSIONS: Socio-structural, economic, and individual interventions are needed to mitigate FI and address the dynamics between FI and cannabis use that could perpetuate disparities related to FI and cannabis use
Rapid Itch Improvement and Skin Clearance with Upadacitinib Versus Placebo (Measure Up 1 and Measure Up 2) and Versus Dupilumab (Heads Up): Results from Three Phase 3 Clinical Trials in Patients with Moderate-to-Severe Atopic Dermatitis
No full textINTRODUCTION: Achievement of stringent outcomes (e.g., ≥ 90% improvement from baseline in Eczema Area and Severity Index [EASI 90] or minimal-to-no itch on the Worst Pruritus Numerical Rating Scale [WP-NRS 0/1]) is associated with a substantial improvement in quality of life among patients with atopic dermatitis (AD). Using stringent outcomes, we evaluated the efficacy of upadacitinib vs placebo and vs dupilumab on rapid itch improvement and skin clearance in patients with moderate-to-severe AD in three phase 3 clinical trials. METHODS: Patients received orally administered upadacitinib 15 mg (UPA15), 30 mg (UPA30), or placebo once daily for 16 weeks in Measure Up 1 and Measure Up 2 and orally administered UPA30 once daily or subcutaneously administered 300 mg dupilumab every 2 weeks (after a 600 mg loading dose) for 24 weeks in Heads Up. Key outcomes included the proportion of patients achieving WP-NRS 0/1, WP-NRS 0, EASI 90, and EASI 100, as well as the proportion of patients achieving composite outcomes (EASI 90 and WP-NRS 0/1; EASI 100 and WP-NRS 0). Patients assessed WP-NRS daily for the first 16 weeks and at scheduled visits thereafter, and investigators assessed EASI at scheduled visits. RESULTS: A greater proportion of patients receiving upadacitinib vs placebo and vs dupilumab achieved WP-NRS 0/1 at week 16 (nominal p \u3c 0.001 vs placebo) and week 24 (nominal p \u3c 0.001 vs dupilumab), with differences as early as the day after treatment initiation (day 2; nominal p \u3c 0.05 vs placebo and vs dupilumab), as well as WP-NRS 0 at week 16 (nominal p \u3c 0.001 vs placebo) and week 24 (nominal p \u3c 0.001 vs dupilumab), with differences as early as day 8 (nominal p \u3c 0.01 vs placebo; nominal p \u3c 0.001 vs dupilumab). A greater proportion of patients receiving upadacitinib vs placebo and vs dupilumab achieved EASI 90 at week 16 (p \u3c 0.001 vs dupilumab), with differences as early as week 1 (nominal p \u3c 0.01 vs placebo; nominal p \u3c 0.05 vs dupilumab), as well as EASI 100 at week 16 (p \u3c 0.001 vs placebo) and week 24 (nominal p \u3c 0.001 vs dupilumab), with differences as early as week 4 (nominal p \u3c 0.001 vs placebo and vs dupilumab). A greater proportion of patients also achieved EASI 90 and WP-NRS 0/1 by week 2 (UPA15: 2.7%, UPA30: 6.7% vs placebo: 0%, nominal p \u3c 0.001; UPA30: 7.1% vs dupilumab: 1.2%, nominal p \u3c 0.001) and EASI 100 and WP-NRS 0 by week 4 (UPA15: 1.6%, UPA30: 3.9% vs placebo: 0.2%, nominal p ≤ 0.01; UPA30: 4.7% vs dupilumab: 0.6%, nominal p \u3c 0.01) through all evaluated time points. CONCLUSIONS: Patients with moderate-to-severe AD treated with upadacitinib rapidly achieved stringent itch improvement and skin clearance targets compared with those receiving placebo or dupilumab, with responses sustained through weeks 16 (Measure Up 1 and Measure Up 2) and 24 (Heads Up). CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; NCT03569293 (Measure Up 1), NCT03607422 (Measure Up 2), and NCT03738397 (Heads Up)
The Impact of Cochlear Implantation in Pediatric Patients on Quality of Life: A Systematic Review and Meta-Analysis
No full textOBJECTIVE: To evaluate the hearing-related quality of life (HR-QoL) instruments utilized to assess pediatric cochlear implant (CI) users and determine which quality of life domains are most relatable to each stage of childhood development. DATABASES REVIEWED: PubMed, OVID Medline, Embase. METHODS: Our systematic review included a search of the PubMed, OVID Medline, and Embase databases using relevant MeSH terminology. Inclusion criteria captured the following: 1) pediatric CI users, 2) QoL measurement outcomes, 3) written in the English language, and 4) numerical data of survey scores readily available. Our study was adherent to the Meta-analysis Of Observational Studies in Epidemiology reporting guidelines. RESULTS: Among 1597 studies screened, 20 met the inclusion criteria. Among 1369 pediatric CI patients surveyed, nearly one-third of the studies administered a pediatric and parental version of the generic KINDL QoL questionnaire. Both children and adolescents with CI scored similarly in the generic HR-QoL and in the specialized Peds QoL questionnaire (CI) (scores displayed in mean ± SD; children: 67.11± 12.6; adolescents: 69.40± 12.42). CI users in both age groups scored lower than their age-matched normal hearing peers (NHP) (79.11 ± 11.63) and to their parents (78.19 ± 10.18) on both the generic and CI-specific QoL questionnaires. The highest scores across studies among CI users were observed under the physical and psychosocial well-being domains. CONCLUSIONS AND RELEVANCE: Children and adolescents with CI experience similar physical and psychosocial functioning QoL aspects, though lower than their NHP. Disagreement was observed between most pediatric and parental QoL reports among children and adolescents at QoL assessment, suggesting parents may not be reliable reporters on their child\u27s overall QoL. These data provide a basis for future discussions aimed at designing standardized HR-QoL measures for pediatric CI users
Treatment of depression by traditional faith healers in Nepal: A qualitative study
No full textThis study explored the assessment and treatment practices of traditional faith healers for patients with depression, as well as their beliefs about the causes of depression, in Nepal. In-depth interviews were conducted using a narrative approach to allow participants to share their experiences and perspectives through storytelling. A vignette depicting a woman with depression symptoms was used to investigate traditional faith healers\u27 beliefs about the character\u27s health issues. The interview guide included questions about the assessment and treatment procedures of traditional faith healers for the character in the vignette. The interviews were conducted between January and July 2023 with 12 traditional faith healers. Traditional faith healers hold diverse beliefs about the causes of depression. Some attribute it to supernatural forces or curses, such as the spirit of a husband or ancestor, while others link it to mental stress, personal and social factors, and lack of support. They employ various methods to assess and treat depression, including examining the patient\u27s face, using rice grains, invoking spirits, creating statues from clay or wheat flour, employing blowing techniques, listening to their suffering, performing death rituals to remove ancestral spirits, shouting, and referring them to hospitals. Collaborating with traditional healers, who act as gateways to mental health care, could improve early detection and treatment of depression. Some traditional healing practices may be helpful for depression, so involving them in identifying and supporting individuals with depression could be beneficial. Future research should evaluate the effectiveness of traditional healing treatments and explore patients\u27 views on these treatments
A Health System-Wide Approach to Addressing Unmet Social Needs Among Children With Asthma
No full textIt is well known that unhealthy housing, financial hardships, and lack of access to resources contribute to higher rates of asthma morbidity and health disparities. Despite extensive literature demonstrating that social factors drive health inequities in pediatric asthma, and although general social risk screening has been used in hospital settings to identify and address health-related social risks, asthma-specific screening models have not been well described. Furthermore, whereas social risk screening involves the identification of specific adverse conditions associated with poor health outcomes, social needs screening shifts the focus to patient and family preferences and priorities, which may facilitate more efficient, effective, and equitable provision of resources. Using the Exploration, Preparation, Implementation, and Sustainment framework, we describe the process of implementing a health system-wide, asthma-specific social needs checklist. The community-based asthma program at our institution had previously implemented social needs screening in 2018, and we report on the process of expanding its use to multiple settings at a single urban pediatric medical center. We evaluate the feasibility, acceptability, and sustainability of implementation in these new settings and describe the social needs of families of children with asthma at our institution. Screening was broadly acceptable to families. Feasibility and sustainability varied by site and was more successful at sites with leadership buy-in and dedicated staffing. Overall, screening revealed a high burden of unmet social needs. Future work includes addressing barriers to screening and studying the impact of a system-wide, longitudinal approach on patient experience and outcomes
Midlife Retinal Microvascular Signs and Late-Life Neuroimaging Features of Cerebral Small Vessel Disease in the ARIC Study
No full textBACKGROUND AND OBJECTIVES: Cerebral small vessel disease (CSVD) is a leading cause of cognitive and functional deficits. Retinal vasculature abnormalities may be an early indicator of CSVD. The aim of this study was to investigate the associations between retinal signs in midlife and imaging markers of CSVD 18 years later. METHODS: This study included participants from the Atherosclerosis Risk in Communities Study, a prospective community-based cohort, who had retinal imaging at visit 3 (1993-1995) and 3T brain MRI at visit 5 (2011-2013). MRI scans were reviewed centrally and rated for white matter hyperintensities (WMHs), lacunes (present vs absent), cerebral microbleeds (present vs absent), brain volumes (total, lobar, temporoparietal meta region of interest, deep gray subcortical structure), global fractional anisotropy (FA) and mean diffusivity (MD) obtained from diffusion tensor imaging. Retinal imaging was evaluated centrally for 4 retinal signs: (1) central retinal arteriolar equivalent-lowest (worst) quartile vs top 3 quartiles; (2) arteriovenous nicking (present vs absent); (3) focal arteriolar narrowing (present vs absent); (4) retinopathy (mild, moderate, severe vs none). We used multivariable-adjusted Poisson regression with robust SEs for lacunes and cerebral microbleeds and linear regression for other MRI measures. Models were adjusted for age, sex, race-center, education, APOE ε4 allele, smoking, drinking, body mass index, hypertension, diabetes, and low-density lipoprotein cholesterol. We also adjusted for intracranial volume when WMHs and brain volumes were analyzed. RESULTS: Among 1,809 participants (mean visit 3 age = 59 years, mean visit 5 age = 77 years, 60% female, 27% Black), comparing participants with focal arteriolar narrowing present vs absent, worse white matter integrity (FA: difference = -0.006, 95% CI -0.010 to -0.001; MD: difference = 0.141 × 10 mm/s, 95% CI 0.047-0.235) and higher WMH burden (difference = 5.119 cm, 95% CI 1.352-8.885) were found, after adjusting for demographic and cardiovascular factors. Retinopathy was associated with cerebral microbleeds (prevalence ratio = 1.597, 95% CI 1.052-2.426). We did not find other significant associations between retinal microvascular signs and brain MRI measures. DISCUSSION: Midlife retinal microvascular abnormalities may be a valuable risk indicator of late-life CSVD neuroimaging markers. Retinal fundus photography might be a promising tool for early identification of CSVD
Peri-Rolandic and Occipital Sparing Cortical Edema: A Prevalent MRI Finding in Pediatric Patients with Cerebral Malaria
No full textBACKGROUND AND PURPOSE: Cerebral malaria is a leading cause of childhood mortality and neurological morbidity in sub-Saharan Africa and South Asia; and a strong association between diffuse brain swelling and mortality has been well established. Our goal was to characterize patterns of cortical edema on brain MRI in children with cerebral malaria and determine their association with patient outcomes. MATERIALS AND METHODS: We retrospectively reviewed admission brain MR images obtained from Malawian children with clinical cerebral malaria admitted at a single center from 2013-2019. Two neuroradiologists assessed the pattern of cortical edema on T1-, T2-, and diffusion-weighted images using a consensus approach. The overall degree of brain volume (brain volume score) and other brain imaging findings were also assessed, including focal signal changes in the basal ganglia, white matter, and posterior fossa. We evaluated the frequency and associations of these imaging findings with clinical outcomes at hospital discharge (deceased, alive with neurological sequelae, or alive without neurological sequelae). RESULTS: We included admission brain MRI scans from 190 children with clinical cerebral malaria. Cortical edema was identified in 163 MRIs. The predominant pattern of cortical edema was diffuse cortical involvement with relative sparing of the occipital and peri-Rolandic areas: 103 (63.2%) had this pattern, whereas 37 (22.7%) had sparing of the occipital cortex only and 23 (14.1%) had generalized cortical edema without focal sparing. The presence of occipital and peri-Rolandic sparing inversely correlated with brain volume score (β=-0.26, p\u3c0.001) and outcomes (OR [95% CI]: 0.3 [0.1-0.6], p=0.002). CONCLUSIONS: Pediatric cerebral malaria is associated with a typical pattern of cortical edema that relatively spares the occipital and peri-Rolandic areas, which become progressively involved with more severe disease. ABBREVIATIONS: CM = Cerebral Malaria; BVS = Brain Volume Score; DWI = Diffusion-Weighted Imaging; PRES = Posterior Reversible Encephalopathy Syndrome
Evaluating Dynamic Smile Outcomes of Free Gracilis Muscle Transfer in Pediatric Facial Palsy Using Image-Based Analysis
No full textBACKGROUND: Facial nerve palsy in children leads to significant functional impairment and facial asymmetry. While free gracilis muscle transfer (FGMT) is a cornerstone technique for smile reanimation in both pediatric and adult patients, its evaluation has mainly focused on the single metric of commissure excursion. This study seeks to evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy using image analysis. METHODS: A retrospective review was conducted in children who underwent FGMT for facial palsy at a major children\u27s hospital between 2007 and 2020. Data collection included pre- and post-operative chart reviews and image analysis. Anthropometric measurements were obtained using a machine learning-based smile analysis software. Primary outcomes included commissure excursion, commissure angle, dental show, and smile symmetry. Statistical analysis was performed using Wilcoxon sign-rank test. RESULTS: A total of 31 patients with an average age of 10 years underwent FGMT for smile reanimation during the study period. The most common diagnosis was Moebius Syndrome (48%). Donor nerves for gracilis neurotization included 18 ipsilateral trigeminal nerves (58.1%) and 12 contralateral facial nerves via cross-face sural nerve grafts (38.7%). Overall, 84% of patients demonstrated active gracilis contraction within a mean of 2.5 years postoperative follow up. Commissure excursion increased by 9.7 mm at one year (p\u3c0.05) and symmetry significantly improved for commissure height, commissure excursion, upper lip height and smile angle. There were no significant improvements in dental show, commissure angle, and symmetry of dental show and lower lip height. Furthermore, only 16% of patients demonstrated clinically symmetric smiles within the follow up period. CONCLUSION: While FGMT effectively restores commissure excursion in pediatric patients with facial palsy, achieving multidimensional smile reanimation remains a challenge. New techniques in multi-vector free tissue transfer may help optimize FGMT outcomes in pediatric patients