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JAMA Otolaryngology-- Head & Neck... Jan 2024Sham-controlled trials are needed to characterize the effect of hypoglossal nerve stimulation (HGNS) therapy on cardiovascular end points in patients with... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Sham-controlled trials are needed to characterize the effect of hypoglossal nerve stimulation (HGNS) therapy on cardiovascular end points in patients with moderate-severe obstructive sleep apnea (OSA).
OBJECTIVE
To determine the effect of therapeutic levels of HGNS, compared to sham levels, on blood pressure, sympathetic activity, and vascular function.
DESIGN, SETTING, AND PARTICIPANTS
This double-blind, sham-controlled, randomized crossover therapy trial was conducted from 2018 to 2022 at 3 separate academic medical centers. Adult patients with OSA who already had an HGNS device implanted and were adherent and clinically optimized to HGNS therapy were included. Participants who had fallen asleep while driving within 1 year prior to HGNS implantation were excluded from the trial. Data analysis was performed from January to September 2022.
INTERVENTIONS
Participants underwent a 4-week period of active HGNS therapy and a 4-week period of sham HGNS therapy in a randomized order. Each 4-week period concluded with collection of 24-hour ambulatory blood pressure monitoring (ABPM), pre-ejection period (PEP), and flow-mediated dilation (FMD) values.
MAIN OUTCOMES AND MEASURES
The change in mean 24-hour systolic blood pressure was the primary outcome, with other ABPM end points exploratory, and PEP and FMD were cosecondary end points.
RESULTS
Participants (n = 60) were older (mean [SD] age, 67.3 [9.9] years), overweight (mean [SD] body mass index, calculated as weight in kilograms divided by height in meters squared, 28.7 [4.6]), predominantly male (38 [63%]), and had severe OSA at baseline (mean [SD] apnea-hypopnea index, 33.1 [14.9] events/h). There were no differences observed between active and sham therapy in 24-hour systolic blood pressure (mean change on active therapy, -0.18 [95% CI, -2.21 to 1.84] mm Hg), PEP (mean change on active therapy, 0.11 [95% CI, -5.43 to 5.66] milliseconds), or FMD (mean change on active therapy, -0.17% [95% CI, -1.88% to 1.54%]). Larger differences between active and sham therapy were observed in a per-protocol analysis set (n = 20) defined as experiencing at least a 50% reduction in apnea-hypopnea index between sham and active treatment.
CONCLUSIONS AND RELEVANCE
In this sham-controlled HGNS randomized clinical trial, mean 24-hour systolic blood pressure and other cardiovascular measures were not significantly different between sham and active HGNS therapy. Several methodologic lessons can be gleaned to inform future HGNS randomized clinical trials.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03359096.
Topics: Adult; Aged; Female; Humans; Male; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Electric Stimulation Therapy; Hypoglossal Nerve; Sleep Apnea, Obstructive; Treatment Outcome; Middle Aged
PubMed: 38032624
DOI: 10.1001/jamaoto.2023.3756 -
JAMA Network Open Oct 2023The prevalence of electronic nicotine delivery systems (ENDS) use among US youths has increased significantly during the past decade. Identifying key factors highly...
IMPORTANCE
The prevalence of electronic nicotine delivery systems (ENDS) use among US youths has increased significantly during the past decade. Identifying key factors highly associated with ENDS use is essential in monitoring and preventing this harmful behavior among youths.
OBJECTIVE
To identify the most important risk factors in wave 4.5 (ie, December 2017 to December 2018) of the Population Assessment of Tobacco and Health Study (PATH) data that are associated with ENDS use in wave 5 (ie, December 2018 to November 2019) among adolescents who were tobacco-naive at baseline.
DESIGN, SETTING, AND PARTICIPANTS
This prognostic study examined data from waves 4.5 and 5 of the PATH youth data set using machine learning techniques. The PATH study is a nationally representative longitudinal cohort study of tobacco use and health in the United States among individuals aged 12 years and older. The data analysis was carried out between January and April 2023.
MAIN OUTCOMES AND MEASURES
Wave 5 current ENDS use status of wave 4.5 adolescents who were tobacco-naive.
RESULTS
The analyzed data set comprised 7943 individuals who were tobacco-naive in wave 4.5. Among this group, 332 participants (4.2%) indicated their present use of ENDS in wave 5, 5047 (63.5%) were aged 12 to 14 years, 4066 (51.2%) were male, and 2455 (30.9%) were Hispanic. The most important risk factors of ENDS use in wave 5 among adolescents who were tobacco-naive in wave 4.5 were the likelihood of using ENDS if offered by a best friend (mean SHAP value, 0.184), the number of best friends using e-cigarettes (mean SHAP value, 0.167), household tobacco usage (mean SHAP value, 0.161), curiosity about ENDS use (mean SHAP value, 0.088), future intention to use ENDS (mean SHAP value, 0.068), youth's total average weekly earnings (mean SHAP value, 0.060), and perceptions of tobacco product safety (mean SHAP value, 0.026).
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that family and friends play an important role in ENDS use among adolescents. The top-ranking factors associated with ENDS use in this study are areas for further exploration, given the increasing prevalence of ENDS use among youths in recent years. Additionally, these findings highlight the important role of families and schools in shaping adolescents' tobacco-related knowledge, which can protect them from using ENDS.
Topics: Humans; Male; Adolescent; United States; Female; Electronic Nicotine Delivery Systems; Longitudinal Studies; Risk Factors; Tobacco Use; Cohort Studies
PubMed: 37862018
DOI: 10.1001/jamanetworkopen.2023.37101 -
Journal of Voice : Official Journal of... Nov 2023Teachers are professional voice users, and the vocal demands in the teaching profession can be considered unique. All teachers will wish to possess a voluminous,...
BACKGROUND
Teachers are professional voice users, and the vocal demands in the teaching profession can be considered unique. All teachers will wish to possess a voluminous, strongly-carrying voice that can be maintained for a prolonged time. This necessitated the need to understand and document the voice-acoustic characteristics of teachers.
OBJECTIVES
The specific objectives were to (a) investigate the acoustic characteristics of teachers' voices, (b) compare voice acoustic characteristics between female and male teachers, and (c) compare acoustic characteristics of voice between teachers and nonteachers.
PARTICIPANTS
Four hundred thirty-nine individuals congregated into two groups. Group 1 had 264 female teachers (mean age: 36.8 years) and 42 male teachers (mean age 36.8 years) with a minimum of 5 years of teaching experience. A hundred females (mean age: 37.3 years) and 33 males (mean age: 36.1 years) adults not indulging in additional, prolonged use of voice were in group 2.
MATERIALS AND METHOD
Sustenance of vowel /a/ for 3 seconds at a comfortable pitch and loudness followed by a monologue on "My school" for 1 minute were audio-recorded at the locations of the participants. Multidimensional Voice Profiles and Real Time Pitch were used to analyze the phonation and monologue samples, respectively.
RESULTS
Revealed that most F0 and its related measures, short- and long-term frequency perturbations were higher in female compared to the male participants. The majority of the acoustic parameters were higher in teachers compared to nonteachers of both sexes.
CONCLUSION
The results, in general, confirmed a few evinced findings in females and males, strengthening the nature-controlled biophysical influence on voice. A few acoustic measures discerned voices of teachers and nonteachers and also females and males in teachers. Nonteachers of both sexes showed better acoustic characteristics of voice against teachers signifying that the extended and prolonged voice use, an occupational demand of the teaching profession, led to vocal loading affecting the acoustic characteristics of teachers' voices.
PubMed: 37973435
DOI: 10.1016/j.jvoice.2023.09.019 -
JAMA Network Open Jul 2023Obesity is a major global health concern. A better understanding of temporal patterns of weight gain will enable the design and implementation of interventions with...
IMPORTANCE
Obesity is a major global health concern. A better understanding of temporal patterns of weight gain will enable the design and implementation of interventions with potential to alter obesity trajectories.
OBJECTIVE
To describe changes in daily weight across 12 months among Australian adults.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study conducted between December 1, 2019, and December 31, 2021 in Adelaide, South Australia, involved 375 community-dwelling adults aged 18 to 65 years. Participants wore a fitness tracker and were encouraged to weigh themselves, preferably daily but at least weekly, using a body weight scale. Data were remotely gathered using custom-developed software.
EXPOSURE
Time assessed weekly, seasonally, and at Christmas/New Year and Easter.
MAIN OUTCOMES AND MEASURES
Data were visually inspected to assess the overall yearly pattern in weight change. Data were detrended (to remove systematic bias from intraindividual gradual increases or decreases in weight) by calculating a line of best fit for each individual's annual weight change relative to baseline and subtracting this from each participant's weight data. Multilevel mixed-effects linear regression analysis was used to compare weight across days of the week and seasons and at Christmas/New Year and Easter.
RESULTS
Of 375 participants recruited, 368 (mean [SD] age, 40.2 [5.9] years; 209 [56.8%] female; mean [SD] baseline weight, 84.0 [20.5] kg) provided at least 7 days of weight data for inclusion in analyses. Across the 12-month period, participants gained a median of 0.26% body weight (218 g) (range, -29.4% to 24.0%). Weight fluctuated by approximately 0.3% (252 g) each week, with Mondays and Tuesdays being the heaviest days of the week. Relative to Monday, participants' weight gradually decreased from Tuesday, although not significantly so (mean [SE] weight change, 0.01% [0.03%]; P = .83), to Friday (mean [SE] weight change, -0.18% [0.03%]; P < .001) and increased across the weekend to Monday (mean [SE] weight change for Saturday, -0.16% [0.03%]; P < .001; mean [SE] weight change for Sunday, -0.10% [0.03%]; P < .001). Participants' weight increased sharply at Christmas/New Year (mean [SE] increase, 0.65% [0.03%]; z score, 25.30; P < .001) and Easter (mean [SE] weight change, 0.29% [0.02%], z score, 11.51; P < .001). Overall, participants were heaviest in summer (significantly heavier than in all other seasons), were lightest in autumn (mean [SE] weight change relative to summer, -0.47% [0.07%]; P < .001), regained some weight in winter (mean [SE] weight change relative to summer, -0.23% [0.07%]; P = .001), and became lighter in spring (mean [SE] weight change relative to summer, -0.27% [0.07%]; P < .001).
CONCLUSIONS AND RELEVANCE
In this cohort study of Australian adults with weekly and yearly patterns in weight gain observed across 12 months, high-risk times for weight gain were Christmas/New Year, weekends, and winter, suggesting that temporally targeted weight gain prevention interventions may be warranted.
Topics: Humans; Adult; Female; Male; Seasons; Cohort Studies; Australia; Weight Gain; Obesity; Body Weight
PubMed: 37498598
DOI: 10.1001/jamanetworkopen.2023.26038 -
Indian Journal of Orthopaedics Sep 2023The aim of this study was to evaluate the role of preoperative embolization in the management of aneurysmal bone cysts.
INTRODUCTION
The aim of this study was to evaluate the role of preoperative embolization in the management of aneurysmal bone cysts.
METHODS
In this study, the data of a total of 19 patients, 11 females and 8 males, with a mean age of 19.6 (range 5-46 years), who were operated on in our hospital with the diagnosis of ABC between January 2015 and January 2021 were retrospectively analyzed. In the specified date range, there were 10 patients with a diagnosis of ABC who were operated on within 48 h after preoperative embolization. For statistical comparison, 9 patients who were operated on without embolization in the same date range were included as the control group.
RESULTS
The mean age of the study group was 16.7 (between 5 and 27 years), while the mean age of the control group was 22.6 (between 16 and 46 years). In the embolization group (group I), the mean intraoperative blood loss was 550 mL (100-1200 mL), the mean intraoperative blood transfusion was 270 mL (0-900 mL), and the mean surgical time was 85 min. In the non-embolization group (group II), the mean intraoperative blood loss was 1250 mL (600-2200 mL), the mean intraoperative blood transfusion was 450 mL (450-1800 mL), and the mean surgical time was 90 min. In comparison, a statistically significant difference was found between the embolization group and the non-embolization group in terms of blood loss and blood transfusion requirement ( = 0.011 and = 0.017, respectively). The mean surgery time was slightly shorter in the embolized group, and there was no significant difference in surgical time between the two groups ( = 0.821).
CONCLUSION
Evidence suggests that preoperative embolization of an aneurysmal bone cyst, performed 0-48 h before surgery, can result in a reduction in intraoperative blood loss and intraoperative blood transfusion volume.
PubMed: 37609013
DOI: 10.1007/s43465-023-00908-4 -
Entropy (Basel, Switzerland) Nov 2023This paper is about Dirichlet averages in the matrix-variate case or averages of functions over the Dirichlet measure in the complex domain. The classical power mean...
This paper is about Dirichlet averages in the matrix-variate case or averages of functions over the Dirichlet measure in the complex domain. The classical power mean contains the harmonic mean, arithmetic mean and geometric mean (Hardy, Littlewood and Polya), which is generalized to the -mean by de Finetti and hypergeometric mean by Carlson; see the references herein. Carlson's hypergeometric mean averages a scalar function over a real scalar variable type-1 Dirichlet measure, which is known in the current literature as the Dirichlet average of that function. The idea is examined when there is a type-1 or type-2 Dirichlet density in the complex domain. Averages of several functions are computed in such Dirichlet densities in the complex domain. Dirichlet measures are defined when the matrices are Hermitian positive definite. Some applications are also discussed.
PubMed: 37998226
DOI: 10.3390/e25111534 -
Preventing Chronic Disease Oct 2023Physical activity positively affects health. Although 94% of Americans know the health benefits of regular physical activity, more than 75% do not achieve recommended...
INTRODUCTION
Physical activity positively affects health. Although 94% of Americans know the health benefits of regular physical activity, more than 75% do not achieve recommended levels. The objective of our study was to identify and define the key components of a physical activity intervention tailored to rural American men.
METHODS
We recruited rural men (N = 447) via Amazon's Mechanical Turk online platform to complete a needs assessment survey focused on their interest in a physical activity intervention, preferred intervention features, and potential intervention objectives. Data were summarized by using descriptive statistics. A cumulative logistic regression model examined associations between the men's perceived importance of physical activity to health and their interest in a physical activity intervention.
RESULTS
Almost all participants (97.7%) rated physical activity as "at least somewhat important" to their health, and 83.9% indicated they would be "at least somewhat interested" in participating in a physical activity intervention. On a scale of 1 (not at all a barrier) to 5 (very much a barrier), motivation (mean 3.4; 95% CI, 3.3-3.5), cold weather (mean, 3.4; 95% CI, 3.3-3.5), and tiredness (mean, 3.3; 95% CI, 3.2-3.4) were rated the biggest barriers to physical activity. Becoming fitter (54.1%) was the top reason for joining a physical activity program. Preferred delivery channels for receiving an intervention were mobile application (ranked from 1 being the most preferred and 9 being the least preferred: mean, 2.8; 95% CI, 2.70-3.09) and e-mail (mean, 4.2; 95% CI, 3.92-4.36). Rural men preferred interventions that taught them how to exercise and that could be done from home.
CONCLUSION
Our findings suggest US men in rural areas are receptive to physical activity programs. A systematic approach and a clear model of development are needed to tailor future physical activity interventions to the special needs of rural men.
Topics: Male; Humans; Exercise; Surveys and Questionnaires
PubMed: 37797290
DOI: 10.5888/pcd20.230046 -
JAMA Network Open Apr 2024Many patients with post-COVID condition (PCC) experience persistent fatigue, muscle pain, and cognitive problems that worsen after exertion (referred to as... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Many patients with post-COVID condition (PCC) experience persistent fatigue, muscle pain, and cognitive problems that worsen after exertion (referred to as postexertional malaise). Recommendations currently advise against exercise in this population to prevent symptom worsening; however, prolonged inactivity is associated with risk of long-term health deterioration.
OBJECTIVE
To assess postexertional symptoms in patients with PCC after exercise compared with control participants and to comprehensively investigate the physiologic mechanisms underlying PCC.
DESIGN, SETTING, AND PARTICIPANTS
In this randomized crossover clinical trial, nonhospitalized patients without concomitant diseases and with persistent (≥3 months) symptoms, including postexertional malaise, after SARS-CoV-2 infection were recruited in Sweden from September 2022 to July 2023. Age- and sex-matched control participants were also recruited.
INTERVENTIONS
After comprehensive physiologic characterization, participants completed 3 exercise trials (high-intensity interval training [HIIT], moderate-intensity continuous training [MICT], and strength training [ST]) in a randomized order. Symptoms were reported at baseline, immediately after exercise, and 48 hours after exercise.
MAIN OUTCOMES AND MEASURES
The primary outcome was between-group differences in changes in fatigue symptoms from baseline to 48 hours after exercise, assessed via the visual analog scale (VAS). Questionnaires, cardiopulmonary exercise testing, inflammatory markers, and physiologic characterization provided information on the physiologic function of patients with PCC.
RESULTS
Thirty-one patients with PCC (mean [SD] age, 46.6 [10.0] years; 24 [77%] women) and 31 healthy control participants (mean [SD] age, 47.3 [8.9] years; 23 [74%] women) were included. Patients with PCC reported more symptoms than controls at all time points. However, there was no difference between the groups in the worsening of fatigue in response to the different exercises (mean [SD] VAS ranks for HIIT: PCC, 29.3 [19.5]; controls, 28.7 [11.4]; P = .08; MICT: PCC, 31.2 [17.0]; controls, 24.6 [11.7]; P = .09; ST: PCC, 31.0 [19.7]; controls, 28.1 [12.2]; P = .49). Patients with PCC had greater exacerbation of muscle pain after HIIT (mean [SD] VAS ranks, 33.4 [17.7] vs 25.0 [11.3]; P = .04) and reported more concentration difficulties after MICT (mean [SD] VAS ranks, 33.0 [17.1] vs 23.3 [10.6]; P = .03) compared with controls. At baseline, patients with PCC showed preserved lung and heart function but had a 21% lower peak volume of oxygen consumption (mean difference: -6.8 mL/kg/min; 95% CI, -10.7 to -2.9 mL/kg/min; P < .001) and less isometric knee extension muscle strength (mean difference: -37 Nm; 95% CI, -67 to -7 Nm; P = .02) compared with controls. Patients with PCC spent 43% less time on moderate to vigorous physical activity (mean difference, -26.5 minutes/d; 95% CI, -42.0 to -11.1 minutes/d; P = .001). Of note, 4 patients with PCC (13%) had postural orthostatic tachycardia, and 18 of 29 (62%) showed signs of myopathy as determined by neurophysiologic testing.
CONCLUSIONS AND RELEVANCE
In this study, nonhospitalized patients with PCC generally tolerated exercise with preserved cardiovascular function but showed lower aerobic capacity and less muscle strength than the control group. They also showed signs of postural orthostatic tachycardia and myopathy. The findings suggest cautious exercise adoption could be recommended to prevent further skeletal muscle deconditioning and health impairment in patients with PCC.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05445830.
Topics: Female; Humans; Male; Middle Aged; COVID-19; Fatigue; Myalgia; SARS-CoV-2; Tachycardia; Adult; Cross-Over Studies
PubMed: 38573638
DOI: 10.1001/jamanetworkopen.2024.4386 -
Internet Interventions Sep 2023As the number of individuals suffering from cognitive diseases continues to rise, dealing with the diminished cognitive function that comes with age has become a serious...
BACKGROUND
As the number of individuals suffering from cognitive diseases continues to rise, dealing with the diminished cognitive function that comes with age has become a serious public health concern. While the use of mobile applications (apps) as digital treatments for cognitive training shows promise, the analysis of their content and quality remains unclear.
OBJECTIVE
The aim of this study was to systematically search and assess cognitive training apps using the multidimensional mobile app rating scale (MARS) to rate objective quality and identify critical points.
METHODS
A search was conducted on the Google Play Store and Apple App Store in February 2022 using the terms "cognitive training" and "cognitive rehabilitation." The cognitive domains provided by each app were analyzed, and the frequency and percentage according to the apps were obtained. The MARS, a mHealth app quality rating tool including multidimensional measures, was used to analyze the quality of the apps. The relationship between the MARS score, the number of reviews, and 5-star ratings were examined.
RESULTS
Of the 53 apps, 52 (98 %) included memory function, 48 (91 %) included attention function, 24 (45 %) included executive function, and 19 (36 %) included visuospatial function. The mean (SD) scores of MARS, 5-star ratings, and reviews of 53 apps were 3.09 (0.61), 4.33 (0.30), and 62,415.43 (121,578.77). From the between-section comparison, engagement (mean 2.97, SD 0.68) obtained lower scores than functionality (mean 3.18, SD 0.62), aesthetics (mean 3.13, SD 0.72), and information (mean 3.11, SD 0.54). The mean quality score and reviews showed a statistically significant association ( = 0.447 and = .001*). As the number of domains increased, the mean quality score showed a statistically significant increasing trend ( = .002*).
CONCLUSIONS
Most apps provided training for the memory and attention domains, but few apps included executive function or visuospatial domains. The quality of the apps improved significantly when more domains were provided, and was positively associated with the number of reviews received. These results could be useful for the future development of mobile apps for cognitive training.
PubMed: 37312799
DOI: 10.1016/j.invent.2023.100632 -
Clinical and Experimental Medicine Oct 2023Long COVID is estimated to occur in 5-10% of individuals after acute SARS-CoV-2 infection. However, the pathophysiology driving the disease process is poorly understood.
PURPOSE
Long COVID is estimated to occur in 5-10% of individuals after acute SARS-CoV-2 infection. However, the pathophysiology driving the disease process is poorly understood.
METHODS
We evaluated urine and plasma inflammatory and immune cytokine profiles in 33 individuals with long COVID compared to 33 who were asymptomatic and recovered, and 34 without prior infection.
RESULTS
Mean urinary leukotriene E4 was significantly elevated among individuals with long COVID compared to asymptomatic and recovered individuals (mean difference 774.2 pg/mL; SD 335.7) and individuals without prior SARS-CoV-2 infection (mean difference 503.1 pg/ml; SD 467.7). Plasma chemokine ligand 6 levels were elevated among individuals with long COVID compared to individuals with no prior SARS-CoV-2 infection (mean difference 0.59 units; SD 0.42). We found no significant difference in angiotensin-converting enzyme 2 antibody levels. Plasma tumor necrosis factor receptor-associated factor 2 (TRAF2) levels were reduced among individuals with long COVID compared to individuals who were asymptomatic and recovered (mean difference = 0.6 units, SD 0.46). Similarly, the mean level of Sarcoma Homology 2-B adapter protein 3 was 3.3 units (SD 1.24) among individuals with long COVID, lower than 4.2 units (SD 1.1) among individuals with recovered, asymptomatic COVID.
CONCLUSION
Our findings suggest that further studies should be conducted to evaluate the role of leukotriene E4 as a potential biomarker for a diagnostic test. Furthermore, based on reductions in TRAF2, long COVID may be driven in part by impaired TRAF2-dependent immune-mediated inflammation and potentially immune exhaustion.
Topics: Humans; Post-Acute COVID-19 Syndrome; COVID-19; Leukotriene E4; TNF Receptor-Associated Factor 2; SARS-CoV-2; Ubiquitin-Protein Ligases; Cytokines
PubMed: 37061998
DOI: 10.1007/s10238-023-01065-6