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Anxiety Sensitivity in the Perinatal Period: A Scoping Review
No full textBackground: Anxiety Sensitivity (AS), the trait-like tendency to interpret anxiety-related sensations as harmful, is a well-established risk factor for anxiety disorders and other mental health conditions. Less is known about the role of AS in perinatal mental health-encompassing pregnancy and the postpartum period-despite the heightened risk for anxiety and anxiety-related disorders such as Obsessive Compulsive Disorder and Posttraumatic Stress Disorder (PTSD).
Objective: The goal of this scoping review was to examine 1) the state of research on AS in perinatal populations, 2) its relationship with mental health and pregnancy-specific outcomes, and 3) its integration into clinical interventions.
Methods: We conducted a systematic literature search using PubMed, Scopus, PsycInfo, CINAHL. Study inclusion criteria were: 1) participants were pregnant or <1 year postpartum, and 2) AS was assessed.
Results: Twenty studies met inclusion criteria. Most studies examined cross-sectional or prospective relationships between AS and mental health and related outcomes, finding positive association between AS and PTSD symptoms, depression symptoms, anxiety symptoms, fetal health anxiety, pregnancy-related anxiety, and fear of childbirth. Results were more mixed for aspects of pain during labor (e.g., anesthetic consumption). Two Randomized Clinical Trials and two case studies included AS as an outcome measure.
Conclusions: This review extends previous findings in the general population by highlighting associations between AS and perinatal mental health. Future research should expand the breadth scope of outcomes assessed and investigate AS as a modifiable target in interventions to enhance perinatal mental health outcomes.No embarg
Satisfied but Failed: Patient Satisfaction Compared with Total Knee Arthroplasty Success Defined by the U.S. Centers for Medicare & Medicaid Services
No full textBACKGROUND: More than 1 million total knee arthroplasties (TKAs) are performed annually in the United States to reduce knee pain, restore physical function, and enhance quality of life. However, nearly 1 in 5 patients are not satisfied after 1 year. We aimed to compare patient satisfaction with the U.S. Centers for Medicare & Medicaid Services (CMS) definition of success in TKA.
METHODS: We studied a multicenter cohort of patients undergoing primary unilateral TKA, comparing patient satisfaction with CMS-defined surgery success, which is a minimum 20-point improvement in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR, scored 0 to 100) at 1 year. We cross-classified surgeries by satisfaction and success and used multivariable logistic regression to identify factors associated with satisfied patients being deemed as having undergone surgeries that failed.
RESULTS: We studied 8,444 patients with a mean age of 68 years (with patients grouped by age: 30 to 64 years and 65 to 95 years). Of the patients, 67% were women and 60% were obese. With regard to the patients' race and/or ethnicity, 81% were White, 17% were Black, 1% were Asian, 0.6% were Native American or Alaskan Native, and 0.3% were native Hawaiian or other Pacific Islander. Although 84% of all patients reported satisfaction with the surgery, only 64% of surgeries were deemed successful. Among satisfied patients, only 71% underwent a surgery that was deemed to be successful, and discordance depended strongly on their baseline score. For satisfied patients with the worst baseline status (KOOS JR of <40), the CMS deemed the surgeries to be successful 91% of the time. In contrast, for satisfied patients with better baseline status (KOOS JR of ≥60), the CMS determined that only 39% of the surgeries were successful. Surgical failure in satisfied patients was also associated with younger age, back pain, contralateral knee pain, lower health literacy, diabetes, and poorer mental health. Including the baseline KOOS JR in the model significantly increased predictive accuracy (the area under the receiver operating characteristic curve rose from 0.58 to 0.79).
CONCLUSIONS: We found substantial discordance between patients' satisfaction with the procedure and how the CMS currently assesses TKA success. A graded success metric, risk-adjusted for patients' baseline status, would align better with satisfaction. It is also worth exploring whether adding a few questions on joint-specific pain and function could better capture meaningful changes in patients whose high baseline status leaves little room for improvement on the KOOS JR.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.No embarg
Medicaid Nutrition Supports Associated With Reductions In Hospitalizations And ED Visits In Massachusetts, 2020-23
No full textThe Massachusetts Medicaid and Children's Health Insurance Program launched the Flexible Services Program to address food insecurity through partnerships with social service organizations under its Section 1115 demonstration waiver. We evaluated the effects of Flexible Services Program nutritional services (or Food Is Medicine programs) on health care use and costs during the first three-year program cycle (January 2020-March 2023). Our analyses pooled data on 20,403 Flexible Services Program participants from seventeen accountable care organizations. In propensity score-weighted analyses, program participation was associated with a 23 percent reduction in hospitalizations and a 13 percent reduction in emergency department visits compared with the number of hospitalizations and visits for 2,108 eligible nonparticipants. Modestly lower health care costs for Flexible Services Program participants were not statistically significant. Health care costs were 2,502 lower among adults with more than ninety days of enrollment during all study years (2020-23). These findings are important for Medicaid policy nationwide as other state Medicaid programs pursue similar Section 1115 demonstrations.No embarg
Multicenter study of association between socioeconomic status and treatment of ruptured cerebral aneurysms compared to unruptured cerebral aneurysms: insights from 4,517 patients using the area deprivation index
No full textBackground: Socioeconomic status influences health outcomes, including cerebrovascular diseases. Patients from socioeconomically deprived areas may present with more severe conditions due to delayed access to care. This study evaluates the association between neighborhood-level deprivation, measured by the Area Deprivation Index (ADI), and the treatment of ruptured intracranial aneurysms (RIAs) compared with unruptured intracranial aneurysms (UIAs) across multiple centers.
Methods: This retrospective cohort study analyzed data from 4517 patients treated for cerebral aneurysms at 10 US comprehensive stroke centers between 2018 and 2024. Patients were stratified by national ADI decile based on their residential addresses. Multivariable logistic regression was used to examine the relationship between ADI and aneurysm rupture (reference being unruptured aneurysms) and controlled for age, sex, smoking history, family history, and race.
Results: Of 4517 total patients, 1260 (27.9%) underwent treatment of RIAs. Multivariable analysis confirmed ADI as an independent predictor of presentation for treatment of RIA (odds ratio (OR)=1.100, 95% confidence interval (CI)=1.068-1.133, P<0.0001) after adjusting for age, sex, smoking history, and race. This corresponds to a 10% increase in likelihood of presenting for treatment of a ruptured vs unruptured intracranial aneurysm with each ADI decile.
Conclusion: Socioeconomic deprivation independently predicts treatment of RIAs compared with the treatment of UIAs. These findings highlight disparities in aneurysm detection and management, emphasizing the need for targeted preventive care and accessible screening programs to mitigate the impact of socioeconomic disadvantage on cerebral aneurysm outcomes.No embarg
Physicians' Experiences Using Secure Messaging for Diabetes Management: A Qualitative Study
Get PDFBackground: The COVID-19 pandemic led to increased demand for remote management of type 2 diabetes using secure messaging, or patient-provider text-based communication. Prior research on secure messaging has described the content of messages sent for type 2 diabetes management and demonstrated its impact on clinical outcomes. However, there is a gap in knowledge about how secure messaging performs as a communication medium for specific tasks in clinical care (eg, prescription management and discussing medical questions). Additional research is needed to understand physicians' experiences using secure messaging to communicate with patients about clinical tasks that support diabetes management.
Objective: This study aims to investigate physicians' experience using secure messaging to communicate with patients about specific clinical tasks for type 2 diabetes management.
Methods: We interviewed a sample of endocrinologists and internists from 2 different medical facilities who have used secure messaging to communicate with adult patients about type 2 diabetes management. Semistructured interviews were used to solicit physicians' experience using secure messaging for 6 specific tasks that support diabetes management: refilling prescriptions, answering nonurgent medical questions, scheduling appointments, discussing test results, making referral requests, and discussing visit follow-up. Interviews were conducted until we achieved saturation of themes for these tasks. Interview data were collected between 2021 and 2023. Qualitative data were analyzed using the framework method for thematic analysis.
Results: We interviewed 6 internists and 4 endocrinologists (n=10). Physicians reported spending between 2 and 5 hours per day messaging with patients. They observed that secure messaging increased the frequency and timeliness of communication, which improved care coordination and facilitated care delivery between visits. This served as a time-efficient way to iterate specific components of treatment plans, including discussing test results, visit follow-up, scheduling, and prescription refill. Physicians were frustrated with the unstructured nature of secure messages. Patients wrote messages that were often disorganized, confusing, or did not have enough information for the provider to take action. This often made answering nonurgent medical questions difficult. In many cases, poorly structured secure messages resulted in lengthy back-and-forth communications between patients and physicians, which sometimes required a phone call or an office visit to resolve.
Conclusions: Physicians reported that secure messaging supports a longitudinal model of care, where patients can iterate their treatment plan between visits. For tasks with well-defined information boundaries, such as scheduling and prescription refill, physicians reported that secure messaging improved the time efficiency of care delivery. Providers experienced challenges using secure messaging for more complex tasks and often reported not receiving sufficient clinical information. We identified a demand for workflow technologies to process incoming secure messages to improve clarity and ensure that messages have sufficient information to inform decisions on the best course of action.No embarg
Trends in Use of IV Vitamin C Among Patients With Sepsis
No full textOBJECTIVES: We sought to determine trends in use of IV vitamin C for hospitalized patients with sepsis in the context of evolving evidence, including a single-center before-after study in late 2016 and several trials in 2019-2021.
DESIGN: Retrospective cohort study.
SETTING: One thousand one hundred fifteen U.S. hospitals contributing to the Premier Healthcare Database, 2008-2021.
PATIENTS: Eleven million three hundred seventy-five thousand three hundred twenty-six adult inpatients with sepsis.
INTERVENTIONS: IV vitamin C, at any point of the hospital stay.
MEASUREMENTS AND MAIN RESULTS: Patients had a median (interquartile range [IQR]) age of 71 years (59-81 yr) and a median (IQR) of 5 comorbidities (4-7 comorbidities); 53.0% were female; on hospital day 1, 6.9% were mechanically ventilated and 7.5% received a vasopressor. Overall, 32,131 patients (0.3%) received IV vitamin C at any point during hospitalization. During the study period, administration fell from 2008, quarter 1 (0.5%) through 2017, quarter 1 (< 0.1%), then rose and peaked in 2020, quarter 1 (0.6%), and fell through 2021, quarter 4 (0.1%). Examining three time periods defined by predetermined cutpoints (2015 quarter 4, when International Classification of Diseases coding for sepsis changed, and 2020 quarter 1, when the COVID-19 pandemic began), vitamin C use also varied (p < 0.001): 0.2% (2008 quarter 1 to 2015 quarter 3); 0.3% (2015 quarter 4 to 2019 quarter 4); and 0.3% (2020-2021). Temporal trends were similar in sicker subcohorts defined by early mechanical ventilation, early vasopressor use, and diagnosis of COVID-19 (2020-2021). A multilevel logistic regression model with data from 91 hospitals that contributed at least 1 sepsis case per quarter showed a similar utilization pattern, with substantial between-hospital variability (median odds ratio, 7.78; 95% CI, 5.45-11.58).
CONCLUSIONS: IV vitamin C prescription for hospitalized patients with sepsis in the United States was overall infrequent over the 14-year study period, rising after the publication of a before-after study and declining in the COVID-19 pandemic as clinical trial results emerged.No embarg
Get Involved, Get Inspired: How to Start Volunteering Now
Get PDFVolunteering offers individuals a meaningful way to engage with and contribute to their communities while also supporting personal and professional development. This tip sheet highlights the benefits of volunteering, addresses common barriers to participation, and provides a five-step guide to help young adults begin their volunteer journey. Whether pursuing academic credit, leadership experience, or social connection, volunteering can be a valuable pathway to growth and opportunity.The contents of this tip sheet were funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), ACL Grant #90RTCP0010, and the Substance Abuse and Mental Health Services Administration, Grant #90RTCP0010. NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this tip sheet do not necessarily represent the policy of NIDILRR, ACL, SAMHSA, or HHS and you should not assume endorsement by the Federal Government.No embarg
Geographic Accessibility to Clinical Trials for Head and Neck Cancers in the United States
No full textHead and neck cancers (HNCs) are becoming more common, thereby gaining greater attention within the medical community. This retrospective trend analysis examined geographical access to HNC clinical trials in the United States from 2005 to 2024, utilizing Census data and the Haversine formula. A search of ClinicalTrials.gov identified 23,450 trial sites, with 18,394 initiated before 2020. Although linear regression revealed a slight annual increase in trial initiation (37.947 trials/year, R² = 0.014, P = .625), most observed trends did not reach statistical significance. The proportion of the population residing within 1 mile of the trials saw a minor increase (0.328%/year, R² = 0.178, P = .064). Accessibility remained consistent throughout the COVID-19 pandemic, despite a decline in trial initiation during 2020. Enhancing access to trials, especially for marginalized populations, could improve patient engagement and clinical results.No embarg
Citrullination of NF-κB p65 by PAD2 as a Novel Therapeutic Target for Modulating Macrophage Polarization in Acute Lung Injury
Get PDFMediating protein citrullination, peptidyl arginine deiminase 2 (PAD2) has recently been reported to influence macrophage phenotypes. However, the mechanisms of PAD2 on macrophage function in Pseudomonas aeruginosa (PA)-induced acute lung injury syndrome (ALI) remains unclear. Utilizing single-cell RNA sequencing and mass spectrometry-based proteomics, a new citrullination site at arginine 171 (R171) is discovered within nuclear factor- κB (NF-κB) p65 catalyzed by PAD2, which modulates PAD2-NF-κB p65-importin α3 pathway and its downstream M1/M2 macrophage polarization. Building on these findings, a cell-specific targeted therapeutic strategy using gold nanoparticles (AuNPs) conjugated with a novel PAD2 inhibitor, AFM41a, and an intercellular adhesion molecule-1 (ICAM-1) antibody is developed. This approach enables the selective delivery of the inhibitor to M1-polarized macrophages in the PA-infected alveolar niche. In vivo, this nanomedicine reduces excessive inflammation and promotes M1-to-M2 polarization to inhibit ALI. This study highlights the role of PAD2-mediated citrullination in macrophage polarization and introduces a promising nanoparticle-based therapy for PA-induced ALI.No embarg
Characteristics of moderate-to-severe chronic pain and its association with daily functional impairment among older outpatients in Vietnam
Get PDFObjective(s): To describe the characteristics of moderate-to-severe chronic pain, and its association with daily functional decline among older individuals attending a large outpatient geriatric clinic in Hanoi, Vietnam.
Methods: A cross-sectional study was undertaken between November, 2019 and March, 2020. In-person structured interviews were conducted in 518 patients 60 years and older with chronic pain. Patient's self-reported pain was categorised into two levels of mild (0-3), moderate to severe (4-10) pain based on a 0-10 scale.
Results: The median age of the study sample was 69 years, women accounted for 74.1%. The knee-foot-leg region was the most common site of chronic pain in both groups (39.5% in mild pain vs. 45.1% in moderate-to-severe pain. Participants experiencing moderate-to-severe pain were more likely to describe their pain as dull (65.5%) or burning (11.3%) and to report pain occurring independently of specific activities (48.7%), compared to those with mild pain (53.9%, 1.2%, and 32.4%, respectively). In a multivariable adjusted model, dependency in activities of daily living (OR: 3.73, 95% CI: 1.82-7.68) and dependency in instrumental activities of daily living (OR: 9.41, 95% CI: 3.94-22.5) were significantly associated with moderate-to-severe pain.
Conclusions: Moderate to severe chronic pain was reported in a high proportion of older Vietnamese outpatients and was associated with impaired daily functional impairment.No embarg